Intramuscular (IM) triamcinolone and oral methylprednisolone are equally effective at managing mild to moderate flares in systemic lupus erythematosus (SLE), but IM triamcinolone may lead to a more rapid response, according to recently published results from the Flares in Lupus: Outcome Assessment Trial (FLOAT).¹

Fifty SLE patients presenting with a mild or moderate flare received either oral methylprednisolone with rapid tapering (medrol dose-pack) or 100 mg triamcinolone, 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 on days 1 and 2 and at weeks 1, 2, 3, and 4. 

Overall, there were comparable responses between the two regimens at day 2 and weeks 1, 3, and 4, the study showed. At day 1, 69.5% of patients receiving triamcinolone responded, compared with 41.6% of patients in the oral methylprednisolone group. In addition to a greater response at day 1, triamcinolone users had a greater response at week 2, compared with the methylprednisolone group, 91.3% versus 58.3%, respectively. 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.

"Triamcinolone has advantages," lead researcher Michelle Petri, MD, MPH, a rheumatologist at the Johns Hopkins University School of Medicine in Baltimore, Maryland, tells CIAOMed. Namely, "the physician gives it, so there are no issues of adherence," Dr. Petri says. "The study shows it may work slightly faster and better, but a few patients may get lipodystrophy, so I think patient choice is important here."
 
The new study is the first randomized trial to compare two methods of giving a steroid boost for mild to moderate flares of SLE. Until now, there had been no evidence that either of the two methods was superior, but researchers speculated that a single IM dose of triamcinolone given in an outpatient setting could provide the advocated steroid dosage and exclude the issue of patient compliance. Lack of patient adherence with short courses of corticosteroids is a particularly vexing problem. In fact, even in solid organ transplants when success depends solely on patient adherence to treatment, a fraction fails to comply.

"The use of IM triamcinolone makes sense in the context of a recent mild/moderate flare in which one does not anticipate the need for a longer use of an anti-inflammatory/immunosuppressive agent, says Jill Buyon, MD, a rheumatologist at the New York Hospital for Joint Diseases in New York City. "This is not likely to have a place in severe organ-threatening disease flares."

Reference

1. Danowski A, Magder L, Petri M. Flares in lupus: outcome assessment trial (FLOAT), a comparison between oral methylprednisolone and intramuscular triamcinolone. J Rheumatol. 2006;33:57-60.