Acute and long-term complications of corticosteroid pulse therapy.

Complications caused by pulse therapy (PT) using "suprapharmacological" doses of methylprednisolone (MP) are reviewed. The reported adverse effects vary between 0 and 56% in different series. More intense and prolonged PT seems to result in higher toxicity. An improvement in therapeutic index for PT over oral corticosteroids has been found in two out of three controlled studies on renal transplant rejection. No controlled studies of PT in SLE have been published. Neuropsychiatric reactions occur in both SLE and RA.