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.
We studied the effects of cyclosporin A (CYA) on the production of various lymphokines and on the suppressor functions of peripheral blood mononuclear cells (MNC) of ten untreated SLE patients. CYA ...was found to inhibit the production of IL-2 and of B cell stimulating factor (BSF) by both normal and SLE MNC but it did not alter the LPS-driven production of IL-1 by either of them. However, it did abrogate the spontaneous release of IL-1 by SLE monocytes. CYA strongly inhibited the production of IL-3-like activity by normal T cells, an effect noticed only on cells from 4 SLE patients, three of whom were in remission. Addition of CYA significantly increased suppressor cell function by cells from all SLE patients. T cell clones could be obtained from two of them by using CYA-conditioned medium containing IL-3. These clones were found to have strong suppressor capacity.
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