Treating neuropsychiatric systemic lupus erythematosus (NPSLE) with intrathecal methotrexate (MTX) and dexamethasone is associated with an improved prognosis, making it a useful additional therapy for patients with NPSLE, especially those with increased protein levels in their cerebrospinal fluid (CSF). The study findings were published in Arthritis Research & Therapy.
The objective of the study was to evaluate the effect of intrathecal treatment, including the outcomes at discharge and the results from a longer follow-up period, among patients with NPSLE.
Researchers conducted a retrospective cohort study between 2013 and 2021, and collected patients’ medical records, relevant clinical manifestations, clinical data, SLE Disease Activity Index 2000 (SLEDAI-2K) scores, as well as demographics, were reviewed.
A total of 5604 patients with SLE were screened, of whom 386 (median age, 30.0 years; 88.4% women) hospitalized patients with NPSLE were included in the analysis. Overall, 194 patients were included in the intrathecal group and 192 in the control group.
In the unmatched analysis, patients who received vs did not receive intrathecal treatment had higher scores on the SLEDAI-2K (median, 17 vs 14 points, respectively) and a greater likelihood of receiving methylprednisolone pulse therapy (71.6% vs 49.5%, respectively; P <.001).
Patients who did (n=147) and did not (n=147) receive intrathecal treatment were propensity score-matched to reduce the differences in covariates between the 2 groups. Among the 386 patients who were unmatched, those who received intrathecal treatment vs control participants were found to have a higher chance of survival and free from NPSLE relapse (P =.042). Among the 147 propensity score-matched pairs, those who received intrathecal treatment vs control participants had a better prognosis (P =.032). Specifically, for the subgroup of patients with NPSLE with elevated protein levels in their CSF, intrathecal treatment had a significantly positive impact on their prognosis (P <.001).
The study may have been limited by potential selection biases due to its retrospective design and that it was conducted at a single center.
However, according to the researchers, “Intrathecal treatment was a protective factor for patients with NPSLE both on a short-term and long-term basis and may serve as a valuable additional therapy for patients [with NPSLE], especially for those with elevated CSF protein levels.”
Nie Y, Sun B, He X, et al. The influence of intrathecal injection of methotrexate and dexamethasone on neuropsychiatric systemic lupus erythematosus (NPSLE): a retrospective cohort study of 386 patients with NPSLE. Arthritis Res Ther. Published online March 28, 2023. doi:10.1186/s13075-023-03030-w