Prednisone, lupus activity, and permanent organ damage.
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 Cox regression models estimated higher hazard ratios at all dose levels.


CONCLUSIONS
Our results suggest that low doses of prednisone do not result in a substantially increased risk of irreversible organ damage.
Thamer
Mae
M
Medical Technology and Practice Patterns Institute, Bethesda, MD 20814, USA.
Hernán
Miguel A
MA
Zhang
Yi
Y
Cotter
Dennis
D
Petri
Michelle
M
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011241:Prednisone / Q000009:adverse effects*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult
D000305:Adrenal Cortex Hormones; D011241:Prednisone