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Autoimmun Rev. 2015 Oct;14(10):875-9. doi: 10.1016/j.autrev.2015.05.011. Epub 2015 Jun 1.

Comparison of high versus low-medium prednisone doses for the treatment of systemic lupus erythematosus patients with high activity at diagnosis.

Author information

1
Autoimmune Diseases Research Unit, Department Of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University Of The Basque Country, Bizkaia, The Basque Country, Spain.
2
Autoimmune Diseases Research Unit, Department Of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University Of The Basque Country, Bizkaia, The Basque Country, Spain; Internal Medicine Department, Hospital De Viseu, Portugal.
3
Autoimmune Diseases Research Unit, Department Of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University Of The Basque Country, Bizkaia, The Basque Country, Spain. Electronic address: r.irastorza@outlook.es.

Abstract

OBJECTIVE:

To compare the efficacy and safety of high vs. low-moderate oral doses of prednisone to treat patients with highly active lupus at diagnosis.

PATIENTS AND METHODS:

Patients from the Lupus-Cruces cohort with an SLEDAI score ≥6 at diagnosis and treated with regimes containing low-medium prednisone doses (≤30 mg/day) were identified (group M). They were matched by sex and SLEDAI score with historical patients treated with high doses (>30 mg/day) at diagnosis (group H). Patients with proliferative nephritis were excluded. The difference in SLEDAI scores between baseline (SLEDAI-0) and year one (SLEDAI-1) was the efficacy variable. Damage at 5 years was calculated using the SLICC damage index (SDI) and regarded as the safety variable. Glucocorticoid related damage was considered in the presence of cataracts, osteonecrosis, osteoporotic fractures and/or diabetes mellitus.

RESULTS:

30 patients were included in each group. Patients in group H received 5-fold higher doses of prednisone, less hydroxychloroquine and less methyl-prednisolone pulses. SLEDAI improvement was similar in both groups. Patients in group H were more likely to accrue new damage (adjusted HR 3.85 (95% CI 1.03-14.2)). No patients in group M suffered glucocorticoid-related damage, vs. 5 patients in group H (p=0.02). The average daily prednisone dose during the first year predicted accrual of new damage (adjusted HR 1.03, 95% CI 1.0-1.07, p=0.056) and accrual of glucocorticoid-related damage (adjusted HR 1.06, 95% CI 1.01-1.13, p=0.03). Likewise, average doses of prednisone >7.5mg/day were an independent predictor of new damage (adjusted HR 4.8, 95% CI 1.2-19.1).

CONCLUSION:

Prednisone doses ≤30 mg/day are similarly effective and safer than higher doses for treating active lupus.

KEYWORDS:

Activity; Avascular osteonecrosis; Cataracts; Damage; Diabetes mellitus; Glucocorticoids; Methyl-prednisolone; Osteoporosis; SLEDAI; Systemic lupus erythematosus

PMID:
26044819
DOI:
10.1016/j.autrev.2015.05.011
[Indexed for MEDLINE]

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