Comparison of the Outcome of Low Dose and High-Dose Corticosteroid in the Treatment of Idiopathic Granulomatous Mastitis

Abstract

Background: Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory breast condition with unknown etiology. Different treatments including corticosteroids have been recommended with no universal consensus. In this study we evaluated the efficacy of low dose vs. high dose prednisolone in treatment of IGM. Methods: In this randomized clinical trial, 30 female patients with IGM were randomly allocated to receive low dose or high dose prednisolone. First group received 5 mg daily prednisolone, while the second group received 50 mg for three days, 25 mg for the next three days and then 12.5 mg for further three days and 5 mg daily afterwards, both for two months. Patients were evaluated 2, 3, 6 and 12 months after treatment. The success and recurrence rate was compared between groups. Results: High dose group had significantly higher rate of remission compared to low dose group (93.3% vs. 53.3%, p=0.03). One patient in high dose group and 5 patients in low dose group underwent lumpectomy due to persistent symptoms. Two other patients in low dose group received high dose treatment after three months due to no change in symptoms. Among patients with remission, recurrence was also significantly lower in high dose compared to low dose prednisolone (0% vs. 37.5%, p=0.04). Conclusion: High dose prednisolone has high success rate with lower recurrence in the treatment of IGM and could reduce the need for surgery. However, further studies are necessary to confirm these findings.

Idiopathic Granulomatous Mastitis: A Rare Confrontation

“…Regarding treatment, our patient showed a dramatic response to high-dose corticosteroids (prednisolone). This supports the findings of a previous research study, emphasizing a higher success rate with lower recurrences by using high-dose steroids [ 8 ]. It is also proposed that steroids possibly reduce the need for surgery [ 9 ].…”

Idiopathic granulomatous mastitis: challenges of treatment in iranian women

“…Among those treated medically, 39% received oral steroids as the first choice of medical treatment, 37% received antibiotics, 13% received antibiotics plus steroids, and 1% received methotrexate; the overall recurrence rate was 17% [ 27 ]. In a study examining the results of treatment in 200 patients with granulomatous mastitis, high-dose corticosteroids were associated with better remission and fewer recurrences [ 28 ].…”

“…However, the etiology of IGM is still unknown, raising debates on its treatment and resulting in no single cure or treatment strategy. Various medical treatments have been reported for IGM including topical and systemic corticosteroids and antibiotics which decreased the recurrence rate [ 4 ], as well as methotrexate [ 5 ], azathioprine [ 6 ], and colchicine. In fact, corticosteroids and surgical excision are known as current treatments [ 2 , 7 – 10 ].…”

Assertive clinical practice in managing patients with idiopathic granulomatous mastitis: Review of literature

“…Language is limited to “English”. There were only 4 review articles and meta-analysis and systemic review [ 39 , 54 , 55 , 61 ], the rest was based on anecdotal data as case reports and case series. We modify our topic during the research process.…”