Medium Versus High Initial Prednisone Dose for Remission Induction in Lupus Nephritis: A Propensity Score-Matched...

Area of Science:

• Nephrology
• Rheumatology
• Immunology

Background:

• Current lupus nephritis (LN) guidelines suggest initial prednisone doses of 0.3-1.0 mg/kg/day.
• Emerging evidence indicates comparable outcomes with lower prednisone dosages.
• This study investigates the efficacy of different initial prednisone doses on renal response in LN.

Purpose of the Study:

• To compare complete renal response rates in lupus nephritis patients treated with initial prednisone doses ≤30 mg/day versus ≥40 mg/day.
• To evaluate the long-term renal outcomes and glucocorticoid-related damage associated with different initial prednisone doses in LN.
• To identify optimal initial prednisone dosing strategies for lupus nephritis management.

Main Methods:

• A cohort of new-onset lupus nephritis patients receiving standard immunosuppressive treatment was analyzed.
• Patients were divided into medium (≤30 mg/day) and high (≥40 mg/day) initial prednisone dose groups.
• Propensity score matching was used to control for baseline differences, with follow-up of at least 12 months. Complete renal response was defined as proteinuria <0.5 gm/day and stable renal function.

Main Results:

• Patients receiving high-dose prednisone (mean 48.6 mg/day) showed significantly higher complete renal response rates at 12 months (61.8%) compared to the medium-dose group (mean 24.2 mg/day, 38.2%; P=0.024).
• This improved response with higher doses was consistent across subgroups, including those with proliferative or nonproliferative LN.
• Complete remission rates remained higher in the high-dose group at 2 and 3 years, although cumulative glucocorticoid dose and damage accrual were similar between groups over time.

Conclusions:

• Higher initial prednisone doses (median 45 mg/day) significantly enhance complete renal response rates in new-onset lupus nephritis within the first year.
• Despite initial advantages, cumulative glucocorticoid dose and damage were comparable at 2-3 years, suggesting no long-term benefit in damage reduction.
• The findings underscore the importance of rapid prednisone tapering and exploring alternative therapeutic strategies to mitigate long-term glucocorticoid toxicity in LN management.