ReviewComparison of high versus low–medium prednisone doses for the treatment of systemic lupus erythematosus patients with high activity at diagnosis
Section snippets
Patients and methods
We identified those patients from the longitudinal Lupus Cruces cohort who entered the cohort at the point of SLE diagnosis presenting with an SLEDAI-2K score ≥ 6 and who were treated with low–medium doses of prednisone (≤ 30 mg/day), They were designed as group M. Each patient was matched with a control patient, selected from our historical cohort according to sex and the SLEDAI-2K score at the time of diagnosis, and who was initially treated with > 30 mg/day of prednisone (group H). Patients with
Results
Thirty patients were included in group M and 30 matched controls in group H (see Table 1 for their demographic, clinical, immunological and therapeutic characteristics). SLEDAI-0 and SDI-0 scores were similar in both groups (Table 1).
Patients in group H received at least a 5-fold higher doses of prednisone during the first year of follow-up: mean (SD) cumulative prednisone dose 9304 (6230) mg, equivalent to a mean (SD) average dose of 25 (17) mg/day, and maximum dose 63.5 (19) mg/day, vs. mean
Discussion
For many years, high dose oral glucocorticoids have constituted the main therapy for active SLE. Indeed, glucocorticoid-induced damage is frequently viewed as the inevitable price to pay for controlling lupus activity and avoiding damage accrual due to lupus [19]. However, no solid data support this approach [20].
On the contrary, recent studies in patients with lupus nephritis point to a similar efficacy of therapeutic schemes using medium doses of prednisone (i.e. ≤ 30 mg/day) in the induction
Competing interests
The authors declare that they have no competing interests.
Take-home messages
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Low–medium doses of prednisone are as effective as high doses in treating patients presenting with high lupus activity.
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Low–medium-dose regimes prevent glucocorticoid-related damage without increasing damage accrual due to lupus.
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The concomitant use of antimalarials and pulse methyl-prednisolone ± immunosuppressive drugs helps decrease prednisone doses.
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Cited by (56)
Eurolupus cyclophosphamide plus repeated pulses of methyl-prednisolone for the induction therapy of class III, IV and V lupus nephritis
2021, Autoimmunity ReviewsCitation Excerpt :This pathway is, in addition, free from those side effects intrinsic to the genomic way [23]. In different studies from the Lupus-Cruces cohort, the frequent use of 125 to 250 mg MP in different types of SLE flares has shown high efficacy for controlling disease activity without significant short or long-term GC-related toxicity [24–26]. In the case of LN, repeated bi-weekly MP after the three initial pulses could offer an additional anti-inflammatory push by the activation of the non-genomic pathway.
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2020, European Journal of Internal MedicineCitation Excerpt :It is generally accepted that, based on previous data, doses of prednisone ≤ 7.5 mg/day and methylprednisolone pulses are generally safe and not associated with damage accrual [45], but some authors have lower the threshold to 5 mg/d of prednisone, suggesting that even lower doses are still associated to damage [46]. Some authors have proven that, in fact, low-medium doses of prednisone (≤ 30 mg/day) seem to be equally effective than higher doses (≥ 30 mg/day) for the treatment of lupus patients with high disease activity (mean SLEDAI 10), encouraging the use of lower doses even in highly active disease [47]. Importantly, it has also been suggested that achieve prolonged remission (more than 5 years) is a realistic goal using low doses of prednisone [48], and even possible to completely withdraw glucocorticoids successfully from treatment [30].
Systemic lupus erythematosus and infections
2020, Systemic Lupus Erythematosus: Basic, Applied and Clinical AspectsProlonged remission in SLE is possible by using reduced doses of prednisone: An observational study from the Lupus-Cruces and Lupus-Bordeaux inception cohorts
2019, Autoimmunity ReviewsCitation Excerpt :Patients from CC were, by protocol, never treated with doses of prednisone >30 mg/d; instead, methyl-prednisolone pulses of 125, 250 or, in severe cases, 500 mg/×3 consecutive days were preferentially prescribed to treat acute disease flares, even those with non-major organ involvement. Likewise, prednisone maintenance doses were never >5 mg/d, early immunosuppressive drugs being used in case this objective could not be accomplished [14,15]. Patients with lupus nephritis were managed according to the Lupus-Cruces nephritis protocol, as previously detailed [16].