Flares in lupus: Outcome Assessment Trial (FLOAT), a comparison between oral methylprednisolone and intramuscular triamcinolone.
OBJECTIVE
Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease characterized by a relapsing-remitting course. When a mild/moderate flare occurs, treatment with corticosteroids is often instituted. There are 2 methods of acutely giving a boost of steroids: triamcinolone injection or a short-term boost of oral prednisone or methylprednisolone. We investigated whether triamcinolone is superior to oral corticosteroids for mild/moderate flare in patients with lupus.


METHODS
In a clinical trial, 50 patients with SLE presenting with a mild or moderate flare [defined using the Safety of Estrogens in Lupus Erythematosus: National Assessment-SLE Disease Activity Index (SELENA-SLEDAI) flare instrument] were randomized to receive oral methylprednisolone with rapid tapering (medrol dose-pack) or triamcinolone 100 mg, given intramuscularly. The patients completed a Likert scale of activity and the Medical Outcomes Study Short Form-36 health status questionnaire on the randomization day, and repeated them the next day, 2 days, one week, 2 weeks, 3 weeks, and one month later.


RESULTS
Complete improvement occurred in 0% at one day, 0% at 2 days, 8.3% at one week, 20.8% at 2 weeks, 20.8% at 3 weeks, and 25% at 4 weeks in the methylprednisolone group versus 4.3% at one day, 4.3% at 2 days, 8.6% at one week, 12.5% at 2 weeks, 30.4% at 3 weeks, and 34.7% at 4 weeks in the triamcinolone group. Improvement in health status by Week 4 occurred in 66.6% of the patients in the methylprednisolone group versus 73.9% in the triamcinolone group.


CONCLUSIONS
The triamcinolone and oral methylprednisolone groups did equally well. Triamcinolone may lead to a more rapid response than the oral methylprednisolone (69.5% vs 41.6% with some improvement at day one).
Danowski
Adriana
A
Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, MD 21205, USA.
Magder
Laurence
L
Petri
Michelle
M
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006304:Health Status; D006801:Humans; D007273:Injections, Intramuscular; D008180:Lupus Erythematosus, Systemic / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D008875:Middle Aged; D055502:Secondary Prevention; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000627:therapeutic use*
D005938:Glucocorticoids; D014222:Triamcinolone Acetonide; D008775:Methylprednisolone