First month prednisone dose predicts prednisone burden during the following 11 months: an observational study from the RELES cohort

Abstract

Aim: To study the influence of prednisone dose during the first month after systemic lupus erythematosus (SLE) diagnosis (prednisone-1) on glucocorticoid burden during the subsequent 11 months (prednisone-2-12). Methods: 223 patients from the Registro Español deLupus Eritematoso Sistémico inception cohort were studied. The cumulative dose of prednisone-1 and prednisone-2-12 were calculated and recoded into a four-level categorical variable: no prednisone, low dose (up to 7.5 mg/day), medium dose (up to 30 mg/day) and high dose (over 30 mg/day). The association between the cumulative prednisone-1 and prednisone-2-12 doses was tested. We analysed whether the fourlevel prednisone-1 categorical variable was an independent predictor of an average dose >7.5 mg/day of prednisone-2-12. Adjusting variables included age, immunosuppressives, antimalarials, methyl-prednisolone pulses, lupus nephritis and baseline SLE Disease Activity Index (SLEDAI).Results: Within the first month, 113 patients (51%) did not receive any prednisone, 24 patients (11%) received average low doses, 46 patients (21%) received medium doses and 40 patients (18%) received high doses. There was a strong association between prednisone-1 and prednisone-2-12 dose categories (p<0.001). The cumulative prednisone-1 dose was directly associated with the cumulative prednisone-2-12 dose (p<0.001). Compared with patients on no prednisone, patients taking medium (adjusted OR 5.27, 95% CI 2.18 to 12.73) or high-dose prednisone-1 (adjusted OR 10.5, 95% CI 3.8 to 29.17) were more likely to receive prednisone-2-12 doses of >7.5 mg/day, while patients receiving lowdose prednisone-1 were not (adjusted OR 1.4, 95% CI 0. 0.38 to 5.2). If the analysis was restricted to the 158 patients with a baseline SLEDAI of ≥6, the model did not change.

Infections in newly diagnosed Spanish patients with systemic lupus erythematosus: data from the RELES cohort

“…Previous data from this cohort support this approach, showing that the dose of prednisone received within the first month is an independent predictor of prednisone burden during the following 11 months. 17 In a similar way, immunomodulatory drugs received within the first year of follow-up have been considered as potential risk factors for infections taking place during the second year.…”

Systemic lupus erythematosus

“…21 The initial dose of prednisolone in the first month of therapy after diagnosis of SLE is predictive of prednisolone doses over the following 11 months. 22 Organ complications secondary to chronic corticosteroid use occur in a dose-dependent manner. The most common complications are musculoskeletal damage, such as osteoporotic fracture, and ocular damage, such as cataracts, and these are also among the first complications to occur.…”

Glucocorticoids in Systemic Lupus Erythematosus. Ten Questions and Some Issues

“…It is unlikely that anti-inflammatory effects increase significantly after prednisone doses have reached 30–40 mg/day, since such doses already result in a saturation of almost 100% of the genomic pathway [ 12 , 19 ]. Recent data suggest that higher initial doses of prednisone are associated with higher cumulative doses [ 21 ] with the well proven result of increasing damage accrual [ 1 , 22 , 23 , 24 , 25 ].…”