Pulse Therapy & Lupus Nephritis: A 40-Year History, 1976–2016

Figure 2

Ten years later, in 1986, the group at the National Institutes of Health reported the long-term results of its trial with monthly pulses of cyclophosphamide and later on, in further trials, confirmed the beneficial effects of high-dose steroids by combining pulses of cyclophosphamide with steroid pulses.

Changing Views
It seems that, in the next decade, attempts to minimize steroid use in patients with systemic lupus erythematosus (SLE) and replacing it with B cell depletion are starting to grow, but even in that scenario, in the beginning, patients will still receive a limited number of pulse steroids. In a just-released paper, 69 SLE experts indicated their preferences to treat serious lupus nephritis, and high-dose steroids are still the first line of treatment, followed by mycophenolate.

In the next decade, it appears that biologics will be included in the standard of care. Currently, the only approved biologic drug for SLE is belimumab. Steroid pulse therapy is expected to continue to be used in periods of exacerbations.

The use of steroid pulse therapy since its publication has gained increased popularity in various clinical autoimmune disease states and is still an option for therapy after 40 years (see Table 1, below).

Morton Scheinberg, MD, PhD, is an internist and rheumatologist at the Hospital Israelita Albert Einstein in São Paulo, Brazil, and director of clinical research at Hospital AACD, also in São Paulo. He received his PhD in immunology from Boston University, a Free Associate Professor from the Universidade São Paulo, and is an ACR Master.

References

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3. Cathcart ES, Scheinberg MA, Idelson BA, Couser WG. Beneficial effects of methylprednisolone ‘pulse therapy in diffuse proliferative lupus nephritis. Lancet. 1976 Jan 24;307(7952):163–166.
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