Relationship between Prednisone, Lupus Activity and Permanent Organ Damage
Mae Thamer, Miguel A. Hernan, Yi Zhang, Dennis Cotter, Michelle Petri, J Rheumatol. 2009 Feb 4.
Bethesda, Maryland - Corticosteroids are the mainstay for treatment of systemic lupus erythematosus (SLE). The potential role of corticosteroid use on the pathogenesis of permanent organ damage requires appropriate adjustment for confounding by disease activity. We estimate the effect of corticosteroids (prednisone dose) on permanent organ damage among persons with SLE.
We identified 525 incident SLE patients 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, 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.
Compared with non prednisone use, the hazard ratio (95% confidence interval) of organ damage for prednisone was 1.16 (0.59, 2.20) for cumulative average doses > 0-180mg/month, 1.50 (0.67, 3.39) for >180-360 mg/month, 1.64 (0.67, 4.06) for >360-540 mg/month, and 2.51 (1.02, 6.19) for >540 mg/month. In contrast, standard Cox regression models estimated higher hazard ratios at all dose levels.
Our results suggest that low doses of prednisone do not result in a substantially increased risk of irreversible organ damage.
Research supported in part by a grant from the Lupus Foundation of America and by NIH grant R01 HL080644.
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