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

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First month prednisone dose predicts prednisone burden during the following 11 months: an observational study from the RELES cohort
  1. G Ruiz-Irastorza1,
  2. M Garcia1,
  3. G Espinosa2,
  4. L Caminal3,
  5. F Mitjavila4,
  6. R González-León5,
  7. B Sopeña6,
  8. J Canora7,
  9. M V Villalba8,
  10. M Rodríguez-Carballeira9,
  11. J M López-Dupla10,
  12. J L Callejas11,
  13. A Castro12,
  14. C Tolosa13,
  15. M E Sánchez-García14,
  16. M Pérez-Conesa15,
  17. N Navarrete-Navarrete16,
  18. A P Rodríguez17,
  19. M T Herranz18 and
  20. L Pallarés19
  21. on behalf of RELES, Autoimmune Diseases Study Group (GEAS)
    1. 1Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Bizkaia, Spain
    2. 2Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain
    3. 3Department of Internal Medicine, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
    4. 4Autoimmune Diseases Unit, Department of Internal Medicine. Hospital Universitario de Bellvitge, L′Hospitalet de Llobregat, Barcelona, Spain
    5. 5Department of Internal Medicine, Hospital Universitario Virgen del Rocío, Sevilla, Spain
    6. 6Department of Internal Medicine, Complejo Hospitalario Universitario de Vigo, Pontevedra, Vigo, Spain
    7. 7Department of Internal Medicine, Hospital Universitario Fuenlabrada, Fuenlabrada, Madrid, Spain
    8. 8Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
    9. 9Department of Internal Medicine, Hospital Universitario Mutua de Terrasa, Barcelona, Spain
    10. 10Department of Internal Medicine, Hospital Universitario Joan XXIII, Tarragona, Spain
    11. 11Department of Internal Medicine, Hospital Universitario San Cecilio, Granada, Spain
    12. 12Department of Internal Medicine, Hospital Universitario Sant Joan de Reus, Reus, Tarragona, Spain
    13. 13Department of Internal Medicine, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain
    14. 14Department of Internal Medicine, Autoimmune Diseases Unit, Hospital Universitario Reina Sofía, Córdoba, Spain
    15. 15Department of Internal Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain
    16. 16Department of Internal Medicine, Hospital Universitario Virgen de las Nieves, Granada, Spain
    17. 17Department of Internal Medicine, Complejo Hospitalario Universitario de Ourense, Orense, Spain
    18. 18Department of Internal Medicine, Hospital J.M. Morales Meseguer, Murcia, Spain
    19. 19Department of Internal Medicine, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, Spain
    1. Correspondence to Dr G Ruiz-Irastorza; r.irastorza{at}outlook.es

    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 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.

    • Systemic Lupus Erythematosus
    • Corticosteroids
    • Disease Activity

    This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

    https://doi.org/10.1136/lupus-2016-000153

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