Publication:

Study of dexamethasone cyclophosphamide pulse therapy in systemic lupus erythematosus

Background Systemic lupus erythematosus (SLE) is always a challenge to the treating dermatologists. Pulse therapy is the use of supra pharmacological doses of drugs to achieve a desired therapeutic effect. The success of dexamethasone cyclophosphamide pulse therapy (DCP) in autoimmune bullous diseases has prompted dermatologists to use DCP in SLE but very few studies are available which objectively measure the outcome of DCP therapy in SLE. The aim of our study is to study the efficacy of dexamethasone cyclophosphamide pulse in patients with SLE and to use objective scoring systems to assess efficacy.

Methods 20 SLE patients who satisfied the inclusion criteria were administered intravenous dexamethasone 100 mg over three days with cyclophosphamide 500 mg on day1, followed by oral cyclophosphamide 50 mg daily. In patients whom cyclophosphamide cannot be used oral azathioprine was given. Response to treatment was assessed using CLASI (cutaneous lupus area severity index), clinical evaluation of dermatological and systemic symptoms and laboratory parameters such as ANA, Anti dsDNA, ESR etc.

Results All the patients showed clinical improvement with statistically significant fall in CLASI scores and anti dsDNA values. The mean duration of pulses required to achieve remission was 9 pulses. No major adverse effects were observed in any of the patients.

Conclusions Dexamethasone cyclophosphamide pulse therapy is an effective and safe option in the management of patients with SLE.