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Dose of Glucocorticoids in Lupus Nephritis at YEAR 1 Predicts Accrual of Damage

June 11 2016 2:00 AM ET via RheumReports RheumReports

Frederic Houssiau analyzed data from the Belgian Louvain Lupus Nephritis Cohort. The objective of the study was to determine the effect of the dose of glucocorticoids taken at year 1 on the accrual of damage in the Lupus Nephritis Cohort.

Facts to remember:

  1. Glucocorticoids are the main cause of damage in patients with SLE

  2. The accrual of damage correlates with the mean daily dose of prednisone

  3. Damage accrual is associated with increased mortality

Currently, there is a trend to use, as much as possible, less glucocorticoids; The RITUXILUP trial is ongoing and recruiting patients with Lupus Nephritis to receive treatment with Rituximab and Mycophenolate Mofetil without daily oral glucocorticoids.

The study presented by Houssiau included data on 146 patients (82% Caucasian) with at least 10 years of follow-up. Six patients died and 14 developed end stage kidney disease.

Damage mainly occured in the following organ systems: renal, musculoskeletal, cardiovascular and ophthalmic (cataract) [damage was measured by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (ACR) Damage Index (SDI)]

Patients with damage (SDI ≠ 0) compared to patients without damage (SDI=0) were older, had a longer follow-up and were on a higher dose of prednisone at 1 year (8.5 mg/day vs 5.7 mg/day, respectively). Patients with SDI ≤1 had a lower dose of prednisone at year 1 compared to patients with SDI >1.

This study found that along with the dose of prednisone at year 1, male sex (compared to female) and renal relapses were predictors of damage.

More importantly, this study confirmed that patients with prednisone ≤4 mg/day at year 1 had a better damage profile compared to patients with prednisone at year 1 > 4 mg/day.

My take-aways:

- 50 % of the Louvain Lupus Nephritis Cohort suffers from chronic damage after 10 years

-The dose of glucocorticoids taken at 1 year is an independent predictor of damage

-Patients with prednisone >4 mg/day at 1 year have a worse damage profile compared to patients with prednisone ≤4 mg/day


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About the Author

Dr. Zahi Touma
Dr. Zahi Touma

Dr. Touma is a clinical epidemiologist and an Assistant Professor of Medicine in the Division of Rheumatology at the University of Toronto, and Staff Physician and Clinician Scientist in the Division of Rheumatology, Toronto Western Hospital and Mount Sinai Hospital. In 2012 he completed his PhD in Clinical Epidemiology and subsequently completed one year of post-doctoral work in Measurement in Clinical Research.

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