In-hospital outcomes of methylprednisolone pulse therapy in the treatment of systemic lupus erythematosus.
- Author:
Magbitang Angeline-Therese D.
;
Rubio Anna Kristina Gutierrez
;
Salido Evelyn Osio
- Publication Type:Journal Article, Original
- MeSH: Human; Male; Female; Adult; Hypoalbuminemia; Serum Albumin; Lupus Erythematosus, Systemic; Nephritis; Kidney Diseases; Proteinuria; Anemia; Liver Diseases; Lymphocyte Count; Methylprednisolone
- From: Philippine Journal of Internal Medicine 2014;52(1):1-7
- CountryPhilippines
- Language:English
-
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: Retrospective
POPULATION: 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 time
of 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.