RESEARCH - Prednisone, lupus activity, and permanent organ damage

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J Rheumatol. 2009 Mar;36(3):560-4. Epub 2009 Feb 4.

Prednisone, lupus activity, and permanent organ damage.

Thamer M, Hernán MA, Zhang Y, Cotter D, Petri M.

Medical Technology and Practice Patterns Institute, Bethesda, MD 20814, USA.

OBJECTIVE: To estimate the effect of corticosteroids (prednisone dose)

on permanent organ damage among persons with systemic lupus

erythematosus (SLE).

METHODS: We identified 525 patients with incident SLE in the Hopkins

Lupus Cohort. At each visit, clinical activity indices, laboratory

data, and treatment were recorded. The study population was followed

from the month after the first visit until June 29, 2006, or

attainment of irreversible organ damage, death, loss to follow-up, or

receipt of pulse methylprednisolone therapy. We estimated the effect

of cumulative average dose of prednisone on organ damage using a

marginal structural model to adjust for time-dependent confounding by

indication due to SLE disease activity.

RESULTS: Compared with non-prednisone use, the hazard ratio of organ

damage for prednisone was 1.16 (95% CI 0.54, 2.50) for cumulative

average doses > 0-180 mg/month, 1.50 (95% CI 0.58, 3.88) for > 180-360

mg/month, 1.64 (95% CI 0.58, 4.69) for > 360-540 mg/month, and 2.51

(95% CI 0.87, 7.27) for > 540 mg/month. In contrast, standard

regression models estimated higher hazard ratios at all dose levels.

CONCLUSION: Our results suggest that low doses of prednisone do not

result in a substantially increased risk of irreversible organ damage.

PMID: 19208608

http://www.ncbi.nlm.nih.gov/pubmed/19208608

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