Background/Purpose

Morbidity and damage due to prednisone use in the treatment of SLE is recognized, but prednisone has been a requisite of lupus nephritis induction regimens.  We examined, by calendar years, the prednisone exposure and urine protein in lupus nephritis patients in a large single-center cohort.

Methods

We identified 76 SLE patients who had: 1) biopsy-proven Class III or IV lupus nephritis 2) cohort visit prior to their biopsy with elevated urine protein (dip stick of 2+ to 4+) and at least 4 cohort visits in the year following their biopsy.  For each patient, the average daily prednisone dose, urine dipstick, serum cholesterol, and systolic blood pressure in the year following the biopsy were calculated. 

Results

The average daily dose of prednisone  was lower in more recent years, but the average urine protein was better.

Table 1.  Mean prednisone dose and urine dipstick scores in the year following renal biopsy, by calendar year and stratified by urine protein level prior to biopsy.

Urine dipstick measure in the visit prior to biopsy	Year	Number of Patients	Average Daily Prednisone Dose in year following biopsy1	Average score on urine dipstick over the year following biopsy2
2	1988-1999	5	10.2	2.1
	2000-2005	10	20.9	1.6
	2006-2012	15	7.6	1.3
3-4	1988-1999	11	19.2	2.7
	2000-2005	24	17.1	2.2
	2006-2012	11	15.2	1.8

¹P-value for differences between years with respect to mean daily dose of prednisone, adjusting for baseline dipstick equals 0.063.

²P-value for difference in mean urine dipstick score by year, adjusting for baseline dipstick score equals 0.047.

Prednisone use above 20mg daily (mean) had a major effect on total cholesterol, but not on systolic blood pressure (mean).

Table 2.  Mean change (from pre-biopsy) in cholesterol and systolic blood pressure by average daily dose of prednisone in the year following biopsy.

Average Daily Prednisone Dose	Sample Size	Mean change in Cholesterol	Mean change in systolic BP
0-9 mg/d	27	-2.3	-2.5
10-19 mg/d	28	-12.3	-5.7
20+	21	25.2	-0.4

Conclusion

Prednisone dose in Class III-IV lupus nephritis has been reduced in recent years, with no deleterious effect on urine protein (in fact there has been improved control of urine dipstick protein).  The effect of prednisone on traditional risk factors was surprising.  Patients receiving more than 20 mg/day of prednisone had a major increase in serum cholesterol. However, in those receiving 10-19 mg/d prednisone, there was a surprising decrease in both cholesterol and systolic blood pressure.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/efficacy-versus-safety-of-prednisone-in-lupus-nephritis-since-1988/