title: First month prednisone dose predicts prednisone burden during the following 11 months: an observational study from the RELES cohort.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Autoimmune Diseases Research Unit, Department of Internal Medicine , BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country , Barakaldo, Bizkaia , Spain.
authors.forename: G
authors.initials: G
authors.lastname: Ruiz-Irastorza
authors.affiliation: Autoimmune Diseases Research Unit, Department of Internal Medicine , BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country , Barakaldo, Bizkaia , Spain.
authors.forename: M
authors.initials: M
authors.lastname: Garcia
authors.affiliation: Department of Autoimmune Diseases , Hospital Clinic , Barcelona , Spain.
authors.forename: G
authors.initials: G
authors.lastname: Espinosa
authors.affiliation: Department of Internal Medicine , Hospital Universitario Central de Asturias , Oviedo, Asturias , Spain.
authors.forename: L
authors.initials: L
authors.lastname: Caminal
authors.affiliation: Autoimmune Diseases Unit, Department of Internal Medicine . Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat , Barcelona , Spain.
authors.forename: F
authors.initials: F
authors.lastname: Mitjavila
authors.affiliation: Department of Internal Medicine , Hospital Universitario Virgen del Rocío , Sevilla , Spain.
authors.forename: R
authors.initials: R
authors.lastname: González-León
authors.affiliation: Department of Internal Medicine , Complejo Hospitalario Universitario de Vigo , Pontevedra, Vigo , Spain.
authors.forename: B
authors.initials: B
authors.lastname: Sopeña
authors.affiliation: Department of Internal Medicine , Hospital Universitario Fuenlabrada , Fuenlabrada, Madrid , Spain.
authors.forename: J
authors.initials: J
authors.lastname: Canora
authors.affiliation: Department of Internal Medicine , Hospital General Universitario Gregorio Marañón , Madrid , Spain.
authors.forename: M V
authors.initials: MV
authors.lastname: Villalba
authors.affiliation: Department of Internal Medicine , Hospital Universitario Mutua de Terrasa , Barcelona , Spain.
authors.forename: M
authors.initials: M
authors.lastname: Rodríguez-Carballeira
authors.affiliation: Department of Internal Medicine , Hospital Universitario Joan XXIII , Tarragona , Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: López-Dupla
authors.affiliation: Department of Internal Medicine , Hospital Universitario San Cecilio , Granada , Spain.
authors.forename: J L
authors.initials: JL
authors.lastname: Callejas
authors.affiliation: Department of Internal Medicine , Hospital Universitario Sant Joan de Reus , Reus, Tarragona , Spain.
authors.forename: A
authors.initials: A
authors.lastname: Castro
authors.affiliation: Department of Internal Medicine , Corporació Sanitària Parc Taulí , Sabadell, Barcelona , Spain.
authors.forename: C
authors.initials: C
authors.lastname: Tolosa
authors.affiliation: Department of Internal Medicine, Autoimmune Diseases Unit , Hospital Universitario Reina Sofía , Córdoba , Spain.
authors.forename: M E
authors.initials: ME
authors.lastname: Sánchez-García
authors.affiliation: Department of Internal Medicine , Hospital Universitario Miguel Servet , Zaragoza , Spain.
authors.forename: M
authors.initials: M
authors.lastname: Pérez-Conesa
authors.affiliation: Department of Internal Medicine , Hospital Universitario Virgen de las Nieves , Granada , Spain.
authors.forename: N
authors.initials: N
authors.lastname: Navarrete-Navarrete
authors.affiliation: Department of Internal Medicine , Complejo Hospitalario Universitario de Ourense , Orense , Spain.
authors.forename: A P
authors.initials: AP
authors.lastname: Rodríguez
authors.affiliation: Department of Internal Medicine , Hospital J.M. Morales Meseguer , Murcia , Spain.
authors.forename: M T
authors.initials: MT
authors.lastname: Herranz
authors.affiliation: Department of Internal Medicine , Hospital Universitario Son Espases, Palma de Mallorca , Islas Baleares , Spain.
authors.forename: L
authors.initials: L
authors.lastname: Pallarés
keywords: Corticosteroids; Disease Activity; Systemic Lupus Erythematosus