Early prednisone therapy in Henoch-Schönlein purpura: A randomized, double-blind, placebo-controlled trial
Received 10 November 2005; received in revised form 3 February 2006; accepted 14 March 2006.
Objective
To evaluate the efficacy of early prednisone therapy in preventing renal and treating extrarenal and renal symptoms in Henoch-Schönlein purpura (HSP) in a placebo-controlled trial.
Study design
A total of 171 patients (84 treated with prednisone and 87 receiving placebo) were included and followed up for 6 months. The endpoints were renal involvement at 1, 3, and 6 months and healing of extrarenal symptoms. The analyses were performed on an intent-to-treat basis.
Results
Prednisone (1 mg/kg/day for 2 weeks, with weaning over the subsequent 2 weeks) was effective in reducing the intensity of abdominal pain (pain score, 2.5 vs 4.8; P = .029) and joint pain (4.6 vs 7.3; P = .030). Prednisone did not prevent the development of renal symptoms but was effective in treating them; renal symptoms resolved in 61% of the prednisone patients after treatment, compared with 34% of the placebo patients (difference = 27%; 95% confidence interval = 3% to 47%; P = .024).
Conclusions
The general use of prednisone in HSP is not supported, but patients with disturbing symptoms may benefit from early treatment, because prednisone reduces extrarenal symptoms and is effective in altering (but not preventing) the course of renal involvement.
Department of Pediatrics and Adolescence, Oulu University Hospital, Oulu; Hospital for Children and Adolescents, University of Helsinki, Helsinki; Department of Pediatrics, Tampere University Hospital, Tampere; Department of Pediatrics, Helsinki University Central Hospital, Jorvi Hospital, Espoo; and Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland.
Reprint requests: Matti Nuutinen, MD, Department of Pediatrics and Adolescence, PO Box 23, Oulu University Hospital, 90029 Oulu, Finland.
ABSTRACT