The Relationship between the Number of Major Organ Involvement and Therapeutic Response of Pulse Dose Methylprednisolone in Systemic Lupus Erythematosus Patients

Adhita Kartyanto; Ayu Paramaiswari; Nyoman Kertia

doi:10.22146/actainterna.98165

The Relationship between the Number of Major Organ Involvement and Therapeutic Response of Pulse Dose Methylprednisolone in Systemic Lupus Erythematosus Patients

https://doi.org/10.22146/actainterna.98165

Adhita Kartyanto^(1*), Ayu Paramaiswari⁽²⁾, Nyoman Kertia⁽³⁾

(1) Internal Medicine Residency Program, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital
(2) Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito General Hospital
(3) Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito General Hospital
(*) Corresponding Author

Abstract

Background. Systemic Lupus Erythematosus (SLE) requires comprehensive and integrated treatment because it can manifest in various organ systems, both non-major and major organs. Pulse doses Methylprednisolone used as induction therapy, it provides dramatic improvement in prognosis in severe lupus through its nongenomic effects. Not all SLE patients who received pulse dose methylprednisolone therapy gives complete response, several factors may influence the therapeutic response, one of which is thought to influence the difference in therapeutic response is the number of major organ involvement.

Objectives. To determine the relationship between the number of major organ involvement and therapeutic response of pulse dose methylprednisolone therapy in SLE patients at Dr. Sardjito Hospital Yogyakarta.

Methods. This study used a retrospective cross-sectional study. The subjects of this study were adult patients with SLE treated in the internal medicine ward at Dr. Sardjito Hospital Yogyakarta and met the inclusion and exclusion criteria from January 1, 2016 to December 31, 2019. The data on the characteristics of the research subjects were taken from the patient's medical records and laboratory data before giving pulse methylprednisolone.

Results. A total of 88 research subjects were taken from medical records. Patients with major organ involvement 1 experienced more complete response (53.8%), major organ involvement 2 mostly partial response (66.7%), major organ involvement 3 (48.6%) and major organ involvement 4 (53.8%) no response, and major organ involvement 5 (75%) partial response. There is a significant relationship with the number of major organ involvement with therapeutic response p<0.001. The correlation coefficient r=0.382 means that the more major organ involvement the less therapeutic response. The results of multivariate analysis showed that only the number of major organ involvement had a dominant effect on the therapeutic response, p=0.001. Regression coefficient 0.797.

Conclusion. The number of major organ involvement significantly affects the success of pulse dose methylprednisolone therapy in SLE patients.

Keywords

SLE, pulse dose methylprednisolone, major organ involvement, therapeutic response

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References

Perhimpunan Rheumatologi Indonesia. rekomendasi perhimpunan rheumatologi Indonesia untuk diagnosis dan pengelolaan lupus eritematosus sistemik. (Perhimpunan rheumatologi indonesia, 2019).

Isbagio, H., Albar, Z. & Kasjmir, Y. Lupus Eritematosus Sistemik. (Interna Publishing, 2009).

D’Cruz, D. P., Khamashta, M. A. & Hughes, G. R. V. Systemic lupus erythematosus. Lancet 369, 587–596 (2007).

Almaani, S., Meara, A. & Rovin, B. H. Update on Lupus Nephritis. CJASN 12, 825–835 (2017).

Patino, G. S., Gonzales, N. L., Vasquez, D. G. & Restrepo, E. M. Heart disease characteristics in patients with systemic lupus erythematosus. Iatreia 26(4):447-56 (2013).

Ramírez, C. F. B. et al. [Hemorrhagic pericarditis and cardiac tamponade in systemic lupus erythematosus. A case report]. Arch Cardiol Mex 75 Suppl 3, S3-96–9 (2005).

Torre, O. & Harari, S. Pleural and pulmonary involvement in systemic lupus erythematosus. Presse Med 40, e19-29 (2011).

Carmier, D., Marchand-Adam, S., Diot, P. & Diot, E. Respiratory involvement in systemic lupus erythematosus. Rev Mal Respir 27, e66-78 (2010).

Kamen, D. L. & Strange, C. Pulmonary manifestations of systemic lupus erythematosus. Clin. Chest Med. 31, 479–488 (2010).

Frangou, E. A., Bertsias, G. & Boumpas, D. T. Cytotoxic-Immunosuppressive Drug Treatment. in Systemic Lupus Erythematosus 533–541 (Elsevier, 2016). doi:10.1016/B978-0-12-801917-7.00062-0.

Kasjmir, Y. I. et al. Rekomendasi Perhimpunan Reumatologi Indonesia untuk Diagnosis dan Pengelolaan Sistemik Lupus Eritematosus. (2011).

Sudoyo, A. W., Bambang, S., Idrus, A., Marcellus, S. K. & Siti, S. Buku Ajar Ilmu Penyakit Dalam Jilid II Edisi IV. (FKUI., 2006).

Chatham, W. W. & Kimberly, R. P. Treatment of lupus with corticosteroids. Lupus 10, 140–147 (2001).

Cervera, R. et al. Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients. Medicine (Baltimore) 82, 299–308 (2003).

Touma, Z., Gladman, D. D. & Urowitz, M. B. ‘Clinical Measures, Metrics, and Indices’. in Dubois’ Lupus Erythematosus and Related Syndromes: Eighth Edition vol. Eighth Edition 563–581 (Elsevier Inc, 2013).

Puapatanakul, P. et al. Interferon-Inducible Protein 10 and Disease Activity in Systemic Lupus Erythematosus and Lupus Nephritis: A Systematic Review and Meta-Analysis. Int J Mol Sci 20, E4954 (2019).

Petri, M. et al. Burden of corticosteroid use in patients with systemic lupus erythematosus: results from a Delphi panel. Lupus 23, 1006–1013 (2014).

Brunner, H. I., Feldman, B. M., Urowitz, M. B. & Gladman, D. D. Item weightings for the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Disease Damage Index using Rasch analysis do not lead to an important improvement. J Rheumatol 30, 292–297 (2003).

Arruza, I. R., Barbosa, C., Ugarte, A. & Irastorza, G. R. Comparison of high versus low-medium prednisone doses for the treatment of systemic lupus erythematosus patients with high activity at diagnosis. Autoimmun Rev 14, 875–879 (2015).

Badsha, H. et al. Low-dose pulse methylprednisolone for systemic lupus erythematosus flares is efficacious and has a decreased risk of infectious complications. Lupus 11, 508–513 (2002).

Zhou, H. Q. et al. Clinical features and outcome of neuropsychiatric lupus in Chinese: analysis of 240 hospitalized patients. Lupus 17, 93–99 (2008).

Kasturi, S. & Sammaritano, L. R. Corticosteroids in Lupus. Rheum. Dis. Clin. North Am. 42, 47–62, viii (2016).

Stojan, G. & Petri, M. HHS Public Access. in Curr Treatm Opt Rheumatol vol. 3 164–172 (2017).

Sinha, A. & Bagga, A. Pulse steroid therapy. Indian J Pediatr 75, 1057–1066 (2008).

Fernandes Moça Trevisani, V., Castro, A. A., Ferreira Neves Neto, J. & Atallah, A. N. Cyclophosphamide versus methylprednisolone for treating neuropsychiatric involvement in systemic lupus erythematosus. Cochrane Database Syst Rev CD002265 (2013) doi:10.1002/14651858.CD002265.pub3.

DOI: https://doi.org/10.22146/actainterna.98165