In-hospital outcomes of methylprednisolone pulse therapy in the treatment of systemic lupus erythematosus

ABSTRACT

BACKGROUND:  Methylprednisolone  Pulse  Therapy  (MPPT)  is standard of care in the management of severe systemic lupus erythematosus (SLE). This treatment, though,  is considered   a   double-edged   sword   due to its life-threatening adverse  effects.  Renal  disease,  liver disease and high dose of the drug are factors proposed to adversely affect outcomes of patients treated  with  MPPT.   Despite   the   widely   accepted use of MPPT, there are no reports describing the outcomes   from   its   use   among   Filipinos   with SLE.OBJECTIVE: To determine the in-hospital outcomes of patients with SLE treated with MPPT and to identify  factors   associated   with   adverse  outcomes.GENERAL STUDY DESIGN:  RetrospectivePOPULATION  Adult  patients  with  SLE  who  were  admitted  in Philippine General  Hospital  and  underwent  MPPT from   January   2008   to   December  2012.METHODS: Patient demographics,  disease  characteristics  on admission, indications for MPPT and in-hospital outcomes   were  extracted.ANALYSIS: Chi-square test and Fisher's exact  test  were  used  to  elicit  association  of  population  characteristics  to  outcomes.RESULTS: Forty-two patients  with  SLE  who  underwent MPPT were included. Majority are females  (98%)  and  most (60%) underwent MPPT within one year of SLE diagnosis.  High   disease   activity   is   seen   at   the timeof MPPT with a mean Mex-SLEDAI score  of  14.69. Infection (83%) is the most common comorbidity.  Anemia, hypoalbuminemia and significant  proteinuria  are the most common  laboratory  abnormalities.  The  top indication for MPPT is nephritis (83.3%). The dose received  by the  majority  (66.7%)   is   one   gram/day for   three   days,   which   is   a   high  dose.Improvement rate is 76% but the in-hospital complication  rate  is  64%  and  mortality  rate   is   21%. Patients with in-hospital complications have significantly lower absolute lymphocyte count (p=0.013), serum albumin (p=0.04) and greater 24-hour proteinuria (p=0.04) at baseline. High-dose MPPT is significantly associated with in-hospital complications (p=0.04) but not mortality. Nephritis (p= 0.04) and low platelet counts at baseline  (p=0.01)  are  associated with  mortality.CONCLUSION:  In this  population,  there  is   a   high  rate   of  improvement  of   lupus  disease  activity  when  MPPT   is used but there is a corresponding high rate of in-hospital  complications  and   mortality.   High   dose  of MPPT seems to be associated with increased in-  hospital complication, while nephritis and low platelet count showed a probable association with mortality. Further studies  on  a  larger  cohort  are  needed.  For  now, the findings of this study may be helpful in developing guidelines on the use  of  MPPT  among Filipino   patients   with  SLE.