The Importance of Pulses in the Modern Era of in-Christian Corticosteroid Pulses

In 1996, a systematic review and meta-analysis by Richards et al. demonstrated a 29% reduction in the odds of an event for pulses versus no pulses. More frequent pulses were associated with an EFS benefit, but only in the historical subgroup. In the contemporary subgroup, there was no significant difference in event-free survival between more or less frequent pulses. With a hazard ratio of 0.96 and a 95% confidence interval of 1.09, pulse frequency had no impact on overall survival or relapse risk.