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THU0015 Efficacy versus Safety of Prednisone in Lupus Nephritis since 1988
  1. M. Petri1,
  2. L.S. Magder2,
  3. T. Bichile1
  1. 1Johns Hopkins University, School of Medicine, Department of Rheumatology
  2. 2University of Maryland, Department of Epidemiology, Baltimore, United States

Abstract

Background 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 is 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

Table 2.

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

Conclusions 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.

Disclosure of Interest : None declared

DOI 10.1136/annrheumdis-2014-eular.3865

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