Intravenous pulse methylprednisolone followed by alternate day corticosteroid therapy in lupus erythematosus: a prospective evaluation.

We explored the feasibility of using intravenous pulse methylprednisolone followed by alternate day steroids for treatment of active systemic lupus erythematosus (SLE) in an attempt to avoid longterm daily steroid therapy. Our study was terminated after 11 trials because sustained control of disease activity was possible in only a minority of patients. Pulse therapy was initially very effective: there was rapid improvement in clinical symptoms, and significant improvement of serum anti-DNA (p less than .01) and C3 (p less than .05), but not in other laboratory tests, within 2 weeks of pulse treatment. On followup, alternate day steroids had to be discontinued in 7 trials; 3 patients experienced recurrence of their presenting symptoms, and 4 demonstrated worsening of laboratory abnormalities reflective of active renal disease. Despite the efficacy of pulse for initial management of active SLE, only 4 patients could be successfully maintained on a subsequent alternate day steroid regimen for prolonged periods.