Ioana Ruiz-Arruza1, Cristiana Barbosa2, Amaia Ugarte1, Guillermo Ruiz-Irastorza3. 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.
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: Jayne Little; Ben Parker; Mark Lunt; John G Hanly; Murray B Urowitz; Ann E Clarke; Juanita Romero-Diaz; Caroline Gordon; Sang-Cheol Bae; Sasha Bernatsky; Daniel J Wallace; Joan T Merrill; Jill Buyon; David A Isenberg; Anisur Rahman; Ellen M Ginzler; Michelle Petri; Mary Anne Dooley; Paul Fortin; Dafna D Gladman; Kristjan Steinsson; Rosalind Ramsey-Goldman; Munther A Khamashta; Cynthia Aranow; Meggan Mackay; Graciela S Alarcón; Susan Manzi; Ola Nived; Andreas Jönsen; Asad A Zoma; Ronald F van Vollenhoven; Manuel Ramos-Casals; Guillermo Ruiz-Irastorza; Sung Sam Lim; Kenneth C Kalunian; Murat Inanc; Diane L Kamen; Christine A Peschken; Soren Jacobsen; Anca Askanase; Jorge Sanchez-Guerrero; Ian N Bruce Journal: Rheumatology (Oxford) Date: 2018-04-01 Impact factor: 7.580
Authors: Rosa M R Pereira; Mariana O Perez; Ana Patrícia Paula; Caio Moreira; Charlles H M Castro; Cristiano A F Zerbini; Diogo S Domiciano; Elaine de Azevedo; Laura M C Mendonca; Marcia Midore Shinzato; Marco Antonio A da Rocha-Loures; Sebastião Radominski; Vera L Szejnfeld Journal: Arch Osteoporos Date: 2021-03-01 Impact factor: 2.617
Authors: G Ruiz-Irastorza; M Garcia; G Espinosa; L Caminal; F Mitjavila; R González-León; B Sopeña; J Canora; M V Villalba; M Rodríguez-Carballeira; J M López-Dupla; J L Callejas; A Castro; C Tolosa; M E Sánchez-García; M Pérez-Conesa; N Navarrete-Navarrete; A P Rodríguez; M T Herranz; L Pallarés Journal: Lupus Sci Med Date: 2016-08-02
Authors: Marc Kästle; Barbara Kistler; Thorsten Lamla; Tom Bretschneider; David Lamb; Paul Nicklin; David Wyatt Journal: Eur J Immunol Date: 2018-09-14 Impact factor: 5.532