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Pulse steroids: how much is enough?

Giovanni Franchin1, Betty Diamond

  • 1Columbia University, Department of Medicine, Division of Rheumatology, 1130 St. Nicholas Ave., Audubon III Room 923, New York, NY 10032, USA. gf2127@columbia.edu

Autoimmunity Reviews
|January 25, 2006
PubMed
Summary
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High-dose intravenous methylprednisolone (MEP) is common for severe autoimmune diseases, but lower doses may be equally effective and safer. Current high-dose protocols may increase infection risk without proven benefit.

Area of Science:

  • Rheumatology
  • Immunology
  • Pharmacology

Background:

  • High-dose pulse intravenous methylprednisolone (MEP) is a standard treatment for severe systemic lupus erythematosus (SLE) and systemic vasculitides.
  • The efficacy and optimal dosing of MEP in these conditions are not definitively established, with many studies being retrospective or uncontrolled.

Purpose of the Study:

  • To evaluate the current practice of high-dose MEP therapy for severe autoimmune diseases.
  • To compare the efficacy and safety of different MEP dosages.
  • To assess the risk of adverse events, particularly serious infections, associated with high-dose MEP.

Main Methods:

  • Review of existing literature on high-dose glucocorticoid (GC) therapy in SLE and vasculitis.
  • Analysis of studies comparing different MEP doses.

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  • Evaluation of reported adverse events, focusing on serious infections.

    • Main Results:

    • Limited comparative data suggest lower-dose MEP pulse therapy may be as effective as very high doses.
    • Recent studies indicate a significant risk of serious infections, potentially dose-dependent.

    Conclusions:

    • The current practice of using very high-dose MEP (1g daily for three days) may not be superior to lower doses and carries a substantial risk of serious infections.
    • Further conclusive studies are needed to determine optimal MEP dosing strategies for severe autoimmune diseases to balance efficacy and safety.