Flares in Lupus: Outcome Assessment Trial (FLOAT), A Comparison Between Oral Methylprednisolone and Intramuscular Triamcinolone

ADRIANA DANOWSKI, LAURENCE MAGDER, and MICHELLE PETRI

ABSTRACT.

Objective. Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease characterized by a relapsing-remitting course. When a mild/moderate flare occurs, treatment with corticosteroids is often instituted. There are 2 methods of acutely giving a boost of steroids: triamcinolone injection or a short-term boost of oral prednisone or methylprednisolone. We investigated whether triamcinolone is superior to oral corticosteroids for mild/moderate flare in patients with lupus.

Methods. In a clinical trial, 50 patients with SLE presenting with a mild or moderate flare [defined using the Safety of Estrogens in Lupus Erythematosus: National Assessment–SLE Disease Activity Index (SELENA-SLEDAI) flare instrument] were randomized to receive oral methylprednisolone with rapid tapering (medrol dose-pack) or triamcinolone 100 mg, given intramuscularly. The patients completed a Likert scale of activity and the Medical Outcomes Study Short Form-36 health status questionnaire on the randomization day, and repeated them the next day, 2 days, one week, 2 weeks, 3 weeks, and one month later.

Results. Complete improvement occurred in 0% at one day, 0% at 2 days, 8.3% at one week, 20.8% at 2 weeks, 20.8% at 3 weeks, and 25% at 4 weeks in the methylprednisolone group versus 4.3% at one day, 4.3% at 2 days, 8.6% at one week, 12.5% at 2 weeks, 30.4% at 3 weeks, and 34.7% at 4 weeks in the triamcinolone group. Improvement in health status by Week 4 occurred in 66.6% of the patients in the methylprednisolone group versus 73.9% in the triamcinolone group.

Conclusion. The triamcinolone and oral methylprednisolone groups did equally well. Triamcinolone may lead to a more rapid response than the oral methylprednisolone (69.5% vs 41.6% with some improvement at day one). (J Rheumatol 2006;33:57-60)

Key Indexing Terms:

SYSTEMIC LUPUS ERYTHEMATOSUS
CORTICOSTEROIDS
FLARES

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From the Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine; and Division of Biostatistics and Bioinformatics, University of Maryland School of Medicine, Baltimore, Maryland, USA.

The Hopkins Lupus Cohort is supported by RO1 AR 43727 and by the Outpatient General Clinical Research Center M01-RR00052.

A. Danowski, MD; M. Petri, MD, MPH, Johns Hopkins University School of Medicine; L. Magder, PhD, University of Maryland School of Medicine.

Address reprint requests to Dr. M. Petri, Division of Rheumatology, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 7500, Baltimore, MD 21205. E-mail: mpetri@jhmi.edu

Accepted for publication August 29, 2005.

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