Why Intensive Steroid Treatment Works For Lupus
Patients with lupus respond well to a novel, intensive treatment approach, referred to as pulse steroids, according to researchers at UT Southwestern Medical Center. They report that the regimen may ultimately control the disease more rapidly than traditional treatment and reduce undesirable, long-term side effects.
Approximately 1.5 million Americans have lupus, an autoimmune disease in which the body attacks healthy tissues, including the brain, blood, skin, heart, kidneys, lungs, and joints. The cause is unknown, although genetics, hormones, and environmental factors are believed to be involved, according to the Lupus Foundation. Women are ten to 15 times more likely to develop the disease than are men.
One common way to treat the inflammation and painful, swollen joints characteristic of lupus is with corticosteroids (steroids, including prednisone, cortisone, hydrocortisone), but these drugs are associated with considerable side effects, including weight gain, acne, fluid retention in the legs, elevated blood pressure, mood swings, and increased risk of glaucoma. Because they can be effective in some patients, a goal of treatment is to maximize the benefits while minimizing exposure to the drugs.
Researchers at UT Southwestern have discovered why a treatment approach that involves giving large doses of corticosteroids repeatedly over several weeks appears to be more effective than the standard treatment, which includes very high doses of intravenous steroids for several days followed by a switch to high oral doses that are gradually reduced to the lowest effective level.
According to Dr. Marilynn Punaro, professor of pediatrics at UT Southwestern and a co-author of the study, “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,” which would be welcome news to lupus patients.
Dr. Punaro and her team often use this pulse steroid approach for lupus patients because it is more effective than the standard method of killing the plasmacytoid dendritic cells, the cells that produce interferon alpha, a protein that promotes the inflammation associated with lupus. Oral corticosteroids administered at lower doses are not able to achieve this effect.
In another recent study, researchers at Baylor Research Institute in Dallas reported that corticosteroids frequently fail patients with lupus because the drugs are not as effective against plasmacytoid dendritic cells as they are in other autoimmune diseases. Two other classifications of drugs used to treat lupus include nonsteroidal anti-inflammatory drugs (NSAIDs) and antimalarial drugs.
Dr. Punaro hopes the results of her team’s work will lead to recommendations on how doctors can treat patients with lupus more effectively. Although steroids, despite their poor side effect profile, will likely always be a short-term fix because they are potent and act quickly, “we hope that this information will enable physicians to be smarter about how they use steroids,” noted Punaro.
UT Southwestern Medical Center