28-Jul-10 2:00 PM  CST

Intensive Corticosteroid Treatment May be Best in Treating Severe Lupus

Dr. Marilyn PunaroLarge doses of corticosteroids given repeatedly over several weeks may be the best method of treatment for people with severe lupus, according to researchers at the UT Southwestern Medical Center in Dallas.

Lupus is an autoimmune disease in which the immune system attacks the body’s connective tissue cells, causing inflammation in the joints, heart, skin, kidneys, lungs and blood cells. In severe cases of lupus, patients are given corticosteroids (such as hydrocortisone, cortisone and prednisone) to control inflammation, usually for a few days intravenously. They are later given gradually smaller doses of oral corticosteroids. According to the researchers, however, a different, more intensive form of treatment—known as pulse treatment—where the patient is given high doses of corticosteroids intravenously over several weeks, is more effective and causes fewer side effects.

“By giving the very high dose early and frequently in the course of the disease, we could actually end up using much less steroids in the long run,” said Dr. Marilynn Punaro, professor of pediatrics at UT Southwestern and co-author of the study, in a news release. “This finding suggests that by doing so, we might be able to get the disease under control more quickly and patients might experience fewer long-term side effects.”

The researchers studied human and animal cells containing lupus and evaluated how different doses of corticosteroids affected cells called plasmacytoid dendritic cells. Plasmacytoid dendritic cells produce interferon alpha, which promotes the inflammation seen in lupus. According to their research, high doses of corticosteroids administered by IV were more effective in killing the plasmacytoid dentritic cells. In fact, oral corticosteroids failed to produce the same effect.

Although highly effective, corticosteroids have many severe side effects associated with long term use, including weight gain, severe acne, hyperglycemia, anxiety and osteoporosis. Punaro says their study proves why pulse treatment is more beneficial, minimizes side effects of corticosteroids and reduces the amount of corticosteroids needed to be used overall.

“If the patient receives very high doses of pulse steroids during the induction period, when steroid-sparing long-term drugs--which take a while to work--are being ramped up to an effective level, then our experience has been that we end up using fewer steroids overall,” Punaro said.

1.5 million Americans suffer from Lupus, according to the Lupus Foundation of America, and more than 16,000 new cases are reported each year across the country. Punaro said the next step in research will be to hold a clinical trial that compares the pulse treatment with standard therapy.  While corticosteroids will always be a treatment option only for the most severe cases of lupus, Punaro also hopes that this research will enable doctors to use less corticosteroids more effectively.

The UT study is available online in Nature magazine.
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