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

G Ruiz-Irastorza; M Garcia; G Espinosa; L Caminal; F Mitjavila; R González-León; B Sopeña; J Canora; M V Villalba; M Rodríguez-Carballeira; J M López-Dupla; J L Callejas; A Castro; C Tolosa; M E Sánchez-García; M Pérez-Conesa; N Navarrete-Navarrete; A P Rodríguez; M T Herranz; L Pallarés

doi:10.1136/lupus-2016-000153

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

Lupus Sci Med. 2016 Aug 2;3(1):e000153. doi: 10.1136/lupus-2016-000153. eCollection 2016.

Authors

G Ruiz-Irastorza¹, M Garcia¹, G Espinosa², L Caminal³, F Mitjavila⁴, R González-León⁵, B Sopeña⁶, J Canora⁷, M V Villalba⁸, M Rodríguez-Carballeira⁹, J M López-Dupla¹⁰, J L Callejas¹¹, A Castro¹², C Tolosa¹³, M E Sánchez-García¹⁴, M Pérez-Conesa¹⁵, N Navarrete-Navarrete¹⁶, A P Rodríguez¹⁷, M T Herranz¹⁸, L Pallarés¹⁹

Affiliations

¹ Autoimmune Diseases Research Unit, Department of Internal Medicine , BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country , Barakaldo, Bizkaia , Spain.
² Department of Autoimmune Diseases , Hospital Clinic , Barcelona , Spain.
³ Department of Internal Medicine , Hospital Universitario Central de Asturias , Oviedo, Asturias , Spain.
⁴ Autoimmune Diseases Unit, Department of Internal Medicine . Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat , Barcelona , Spain.
⁵ Department of Internal Medicine , Hospital Universitario Virgen del Rocío , Sevilla , Spain.
⁶ Department of Internal Medicine , Complejo Hospitalario Universitario de Vigo , Pontevedra, Vigo , Spain.
⁷ Department of Internal Medicine , Hospital Universitario Fuenlabrada , Fuenlabrada, Madrid , Spain.
⁸ Department of Internal Medicine , Hospital General Universitario Gregorio Marañón , Madrid , Spain.
⁹ Department of Internal Medicine , Hospital Universitario Mutua de Terrasa , Barcelona , Spain.
¹⁰ Department of Internal Medicine , Hospital Universitario Joan XXIII , Tarragona , Spain.
¹¹ Department of Internal Medicine , Hospital Universitario San Cecilio , Granada , Spain.
¹² Department of Internal Medicine , Hospital Universitario Sant Joan de Reus , Reus, Tarragona , Spain.
¹³ Department of Internal Medicine , Corporació Sanitària Parc Taulí , Sabadell, Barcelona , Spain.
¹⁴ Department of Internal Medicine, Autoimmune Diseases Unit , Hospital Universitario Reina Sofía , Córdoba , Spain.
¹⁵ Department of Internal Medicine , Hospital Universitario Miguel Servet , Zaragoza , Spain.
¹⁶ Department of Internal Medicine , Hospital Universitario Virgen de las Nieves , Granada , Spain.
¹⁷ Department of Internal Medicine , Complejo Hospitalario Universitario de Ourense , Orense , Spain.
¹⁸ Department of Internal Medicine , Hospital J.M. Morales Meseguer , Murcia , Spain.
¹⁹ Department of Internal Medicine , Hospital Universitario Son Espases, Palma de Mallorca , Islas Baleares , Spain.

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.

Keywords: Corticosteroids; Disease Activity; Systemic Lupus Erythematosus.