Background Glucocorticoids (GC) pulses (750mg/day for 3 consecutive days) represent the induction arm of lupus nephritis trial (1) and are commonly used in clinical practice. This regimen can be complicated by adverse events as recently stressed by a EULAR Consensus Committee (2). Current knowledge showed that pulses IV methylprednisolone (250 mg/day) are known to both saturate glucocorticoid receptors and assure a complete non genomic effect (3).

Objectives To evaluate the effectiveness and safety of 250 mg IV methylprednisolone pulses in combination with immunosuppressive therapy in the treatment of lupus nephritis.

Methods Twelve SLE patients (female 89%) aged from 21 to 70 years (median 33.5) and with disease duration ranging from 0.5 to 24 years (median 9.5), all of whom satisfied 2012 ACR criteria (4) for the classification of SLE, were evaluated in the study. All of them had active nephritis based on proteinuria >0.5 g/24h and active urinary sediment or biopsy and 7 patients had impairment of renal function (i.e.,serum creatinine >1.2 mg/dl). All were treated between 2012 to 2013 by EURO-Lupus nephritis regimen modified only in the range of 3 daily pulses of 250 mg IV methylprednisolone (instead of 750mg). Clinical response was evaluated at 3 and 6 months according to response criteria indicated in Euro-lupus nephritis trial (1) and the recently proposed outcome measures for lupus nephritis (5). Adverse events occurring from study inclusion to the last follow up visit were recorded.

Results At enrollement patients presented an ECLAM score ranging from 1 to 10 (median 7), a SLEDAI score ranging from 3 to 18 (median 12); 24 hour proteinuria ranging from 0.675 to 14 g (median 2.86 g), serum creatinine ranging from 0.5 to 2.1 mg/dl (median 1 mg/dl). Three patients underwent a renal biopsy that pointed out a proliferative lupus glomerulonephritis (2 patients WHO class III-1 patient WHO class V). The table shows the changes detected at 3 and 6 months.

No adverse events were registered.

Conclusions Preliminary data of this ongoing study seem to indicate that pulse methylprednisolone (250mg/day) might be as effective as the used 750mg dosage as induction therapy for lupus nephritis.

References

1. Houssiau F A, et al. Arthritis Rheum 2002, 46: 2121–31

2. Duru N, et al. Ann Rheum Dis 2013;72:1905-13.

3. Buttgereit F, et al. Arthritis Rheum 2004. 50: 3408–17

4. Petri M, et al. Arthritis Rheum 2012;64:2677-86.

5. Wofsy D, et al. Arthritis Rheum 2013 65: 1586–91

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.4227