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Prednisone dose following SLE diagnosis may predict prednisone burden at 1 year
The dose of prednisone for the first month following a diagnosis of systemic lupus erythematosus may predict the prednisone burden 11 months later, according to recently published research.
Researchers enrolled 223 patients from the Registro Español de Lupus Eritematoso Sistémico inception cohort from 32 internal medicine cohorts in Spain. Of these, 158 patients had an average SLEDAI score of 6 or higher at the time of first diagnosis of systemic lupus erythematosus (SLE).
The cumulative dose for 11 months of prednisone treatment (prednisone-1-12) was calculated and compared to the dose at the first month of treatment (prednisone-1) in milligrams per day. Results were categorized as no prednisone, low prednisone, medium prednisone and high prednisone use.
In the first month following diagnosis, no prednisone was received by 113 patients; 24 patients received low doses; 46 patients received medium doses; and 40 patients were prescribed high doses. Medium and high doses of prednisone were correlated with the presence of nephritis (odds ratio [OR] = 4.1), thrombocytopenia (OR = 4.3), anti-ds-DNA antibodies (OR = 2.1) and SLEDAI scores of 6 or greater (OR = 2.8).
Patients (54%) treated with medium doses of prednisone-1 received medium doses of prednisone-2-12, while 75% of patients who received high doses at baseline were likely to receive doses of greater than 7.5 mg/day through month 12. Patients who received low doses in the first month were not likely to receive high doses through prednisone-2-12. Adjustment for baseline SLEDAI, age and presence of nephritis, and use of antimalarials, immunosuppressive drugs and pulse methyl-prednisolone did not affect the results.
“Glucocorticoids constitute one of the main therapies for SLE,” the researchers wrote. “However, despite their proven efficacy, oral glucocorticoids are important predictors of irreversible damage in lupus. Therefore, new ways of treating lupus beyond the use of high-dose oral prednisone are needed.”
Disclosure: The researchers report no relevant financial disclosures.