Controlled clinical trial of IV cyclophosphamide versus IV methylprednisolone in severe neurological manifestations in systemic lupus erythematosus.

BACKGROUND: Severe neurological involvement in systemic lupus erythematosus (NPSLE) is one of the most dreadful complications of the disease. OBJECTIVE: To identify the best drug, dose, and treatment. PATIENTS AND METHODS: The study was a controlled clinical trial at two tertiary care centres of patients with SLE according to the ACR criteria, with incident (no more than 15 days) onset of severe NP manifestations such as seizures, optic neuritis, peripheral or cranial neuropathy, coma, brainstem disease, or transverse myelitis. Induction treatment with 3 g of IV methylprednisolone (MP) followed by either IV monthly cyclophosphamide (Cy) versus IV MP bimonthly every 4 months for 1 year and then IV Cy or IV MP every 3 months for another year. The primary end point was response to treatment: at least 20% improvement from basal conditions on clinical, laboratory, or specific neurological testing variables. RESULTS: Overall, a response rate of 75% was observed. Of the 32 patients studied, 18/19 receiving Cy and 7/13 receiving MP responded to treatment (p<0.03). CONCLUSIONS: Cy seems to be more effective than MP in the treatment of acute, severe NPSLE.

[Antibodies against prolactin in patients with systemic lupus erythematosus and hyperprolactinemia]. / Autoanticuerpos dirigidos contra prolactina en pacientes con lupus eritematoso sistémico e hiperprolactinemia.

We investigated patients with lupus erythematosus to detect the presence of hyperprolactinemia and to determine it's origin. From the seric specimens obtained in 225 patients with LES, we found 37 (14.5%) with hyperprolactinemia and they were trated with polyethylenglicol, in 11 of 37 patients (29.7%) had a high significance of prolactin precipitation (PRL). The test in gel filtration shown the big-big PRL (Molecular weight > 100 kDa) was the predominant form from PRL seric in these patients and no woman had clinic effects of hyperprolactinemia as galactorrhea and/or amenorrhea. The big-big PRL essence was due to an antibody, with it was found like a immune complex (Ig-PRL). This evidence suggest the patients with LES and hyperprolactinemia have a very high incidence of macroprolactinemia relationated to antibodies anti-PRL, and in spite of the hyperprolactinemia not have clinical effects like amenorrhea and/or galactorrhea, and it is other cause to explain the high incidence of hyperprolactinemia in patients with LES.