Dose effect of corticosteroids on peripheral lymphocyte profiles in patients with systemic lupus erythematosus

To investigate the dose effect of methylprednisolone (MP) on peripheral lymphocyte profiles in patients with systemic lupus erythematosus (SLE). This study investigated the impact of varied MP doses on peripheral lymphocyte subtypes in SLE patients.

We conducted a prospective study involving 51 SLE patients, categorized into four groups (40 mg/day, 80 mg/day, 500 mg/day, and 1000 mg/day) based on the administered MP dosage during hospitalization. We analyzed the lymphocyte count and proportion in peripheral blood, along with their subpopulations, before and after MP treatment using the paired Mann-Whitney U test.

Treatment with a clinically rational dose of MP (40 mg/day or 80 mg/day) resulted in increased lymphocyte counts, encompassing total lymphocytes, T cells, CD4 + T cells, regulatory T cells (Treg), and effector T cells (Teff) in the short term. Conversely, the counts of these cells decreased with pulse MP (500 mg/day or 1000 mg/day). The percentage of Treg cells and the Treg/Teff ratio increased following 40 mg or 80 mg MP/day treatment, whereas they decreased after pulse therapy. A gradual augmentation in the count and percentage of Treg cells was observed during continuous administration of 40 mg or 80 mg MP/day for 1 week, while in patients receiving pulse therapy, Treg cells tended to decrease during the therapy but rapidly recovered upon MP reduction.

Lower doses of MP in the short term increased Treg cells, inhibiting systemic inflammation in SLE. High-dose pulse therapy exhibited a suppressive effect on Tregs. Key Points • Different dosages of methylprednisolone have variable effects on peripheral lymphocyte subsets. • Methylprednisolone pulse therapy leads to a rapid decrease in Treg cells. • Clinically rational methylprednisolone treatment leads to an increase in Treg cells.