Medium versus high initial prednisone dose for remission induction in lupus nephritis: A propensity score matched analysis Academic Article uri icon

  •  
  • Overview
  •  
  • Research
  •  
  • Identity
  •  
  • View All
  •  

abstract

  • BACKGROUND: The existing guidelines for lupus nephritis (LN) recommend initial prednisone doses of 0.3-1mg/kg/day. However, recent studies reported non-inferior outcomes with lower doses. The aim of this study was to compare the complete renal response rates in LN patients treated with prednisone ≤30mg/day or ≥40mg/day. PATIENTS-METHODS: Patients with new-onset LN and standard immunosuppressive treatment were followed for at least 12 months, divided into medium (≤30mg/day) and high prednisone groups (≥40mg/day) and matched (propensity score) based on the baseline differences. Complete renal response was defined as proteinuria <0.5g/day and no worsening in renal function. Glucocorticoid-related damage was also assessed. RESULTS: High prednisone patients (n=103, mean dose 48.6±12.3 mg/day) achieved better rates of complete response compared to the medium group (n=103, mean dose 24.2±4.6 mg/day) [61.8% vs. 38.2%, p=0.024] at 12 months. The difference in response rates was reproduced for several subgroups (concomitant immunosuppressive treatment, proliferative/non-proliferative LN). Complete remission rates were higher at two [67.8% vs. 39%, p=0.002] and three years [64.9% vs. 49.1%, p=0.025] after LN diagnosis. Cumulative glucocorticoid dose was comparable at two and three years. Glucocorticoid-related damage was accelerated in both groups for the same period. CONCLUSION: Higher initial prednisone doses (median 45mg/day) achieved significantly better rates of complete renal response at 12 months in new-onset LN. Cumulative glucocorticoid dose and damage accrual was not different at 2 and 3 years after LN. Damage was more prominent in the late phases of LN in both groups, underlining the importance of rapid tapering and the need to implement alternative strategies.

publication date

  • March 4, 2021