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

Ruiz-Irastorza, G. ; Garcia, M. ; Espinosa, G. ; Caminal, L. ; Mitjavila, F. ; González-León, R. ; Sopenã, B. ; Canora, J. ; Villalba, M.V. ; Rodríguez-Carballeira, M. ; López-Dupla, J.M. ; Callejas, J.L. ; Castro, A. ; Tolosa, C. ; Sánchez-Garciá, M.E. ; Pérez-Conesa, M. (Universidad de Zaragoza) ; Navarrete-Navarrete, N. ; Rodríguez, A.P. ; Herranz, M.T. ; Pallarés, L.

Resumen: 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 de Lupus 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 four-level 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 low-dose 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. Conclusion: The dose of prednisone during the first month after the diagnosis of SLE is an independent predictor of prednisone burden during the following 11 months.

Idioma: Inglés

DOI: 10.1136/lupus-2016-000153

Año: 2016

Publicado en: Lupus Science and Medicine 3, 1 (2016), e000153 [6 pp]
ISSN: 2053-8790

Factor impacto SCIMAGO: 1.248 - Medicine (miscellaneous) (Q1) - Immunology (Q2)

Tipo y forma: Artículo (Versión definitiva)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)