Flares in Lupus: Outcome Assessment Trial (FLOAT), a comparison between oral methylprednisolone and intramuscular triamcinolone

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).