کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
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3341560 | 1214221 | 2015 | 5 صفحه PDF | دانلود رایگان |
ObjectiveTo compare the efficacy and safety of high vs. low–moderate oral doses of prednisone to treat patients with highly active lupus at diagnosis.Patients and MethodsPatients from the Lupus-Cruces cohort with an SLEDAI score ≥ 6 at diagnosis and treated with regimes containing low–medium prednisone doses (≤ 30 mg/day) were identified (group M). They were matched by sex and SLEDAI score with historical patients treated with high doses (> 30 mg/day) at diagnosis (group H). Patients with proliferative nephritis were excluded. The difference in SLEDAI scores between baseline (SLEDAI-0) and year one (SLEDAI-1) was the efficacy variable. Damage at 5 years was calculated using the SLICC damage index (SDI) and regarded as the safety variable. Glucocorticoid related damage was considered in the presence of cataracts, osteonecrosis, osteoporotic fractures and/or diabetes mellitus.Results30 patients were included in each group. Patients in group H received 5-fold higher doses of prednisone, less hydroxychloroquine and less methyl-prednisolone pulses. SLEDAI improvement was similar in both groups. Patients in group H were more likely to accrue new damage (adjusted HR 3.85 (95% CI 1.03–14.2)). No patients in group M suffered glucocorticoid-related damage, vs. 5 patients in group H (p = 0.02). The average daily prednisone dose during the first year predicted accrual of new damage (adjusted HR 1.03, 95% CI 1.0–1.07, p = 0.056) and accrual of glucocorticoid-related damage (adjusted HR 1.06, 95% CI 1.01–1.13, p = 0.03). Likewise, average doses of prednisone > 7.5 mg/day were an independent predictor of new damage (adjusted HR 4.8, 95% CI 1.2–19.1).ConclusionPrednisone doses ≤ 30 mg/day are similarly effective and safer than higher doses for treating active lupus.
Journal: Autoimmunity Reviews - Volume 14, Issue 10, October 2015, Pages 875–879