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

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.

• Authors: Ioana Ruiz-Arruza, Cristiana Barbosa, Amaia Ugarte, Guillermo Ruiz-Irastorza
• Journal: Autoimmunity reviews (Autoimmun Rev) Vol. 14 Issue 10 Pg. 875-9 (Oct 2015) ISSN: 1873-0183 [Electronic] Netherlands
• PMID: 26044819 (Publication Type: Comparative Study, Journal Article, Review)
• Copyright: Copyright © 2015 Elsevier B.V. All rights reserved.

Chemical References

• Glucocorticoids
• Hydroxychloroquine
• Prednisone
• Methylprednisolone

Topics

• Glucocorticoids (administration & dosage, therapeutic use)
• Humans
• Hydroxychloroquine (therapeutic use)
• Lupus Erythematosus, Systemic (diagnosis, drug therapy)
• Methylprednisolone (therapeutic use)
• Prednisone (administration & dosage, therapeutic use)