Document resource
Objective Methylprednisolone pulses (MP) help achieve prolonged remission in patients with moderate–severe systemic lupus erythematosus (SLE), but their potential effect in reducing damage accrual has not been addressed. This study aims to disclose whether MP given within the first year of follow-up could impact long-term damage accrual.Methods Observational study using clinical care data of patients included in the Lupus–Cruces–Bordeaux cohort, expanded with patients from the historic Lupus Cruces cohort, with a follow-up time ≥5 years and up to 10 years. The primary outcome was the presence of irreversible organ damage or death for any cause during the whole follow-up time; the early outcome was set at 5 years. In addition, specific SLE-related and GC-related, cardiovascular and other forms of damage were also assessed as outcomes. The effect of MP was evaluated by Kaplan-Meier survival curves and propensity score (PS)-adjusted Cox models, in the whole cohort and in groups of mild activity (Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) <6) and moderate–severe activity (SLEDAI≥6).Results 469 patients were included, of whom 99 (21%) received MP. In the PS-adjusted Cox models, MP was associated with a significantly reduced risk for the primary outcome (adjusted HR 0.63, 95% CI 0.40 to 0.98, p=0.044), with the effect being significant also at 5 years (adjusted HR 0.61, 95% CI 0.37 to 0.98, p=0.042). The stratified analyses revealed that the benefit was restricted to the group of patients with moderate/severe activity and mainly in lupus and glucocorticoid-related damage items.Conclusions This study supports the role of the early MP in reducing long-term damage accrual and death, especially among patients with moderate/severe activity.