Higher Prednisone Doses Lead to Complete Response in Lupus Nephritis Patients

A recent study published in Arthritis Care & Research illustrated how higher dosages of prednisone lead to better outcomes for lupus nephritis (LN) patients. After one year, participants were found to have much better complete renal response rates than patients who just experienced the onset of the disease.

As prednisone, like other glucocorticosteroids, can result in adverse events, medical professionals are trying to lower their use. Previous studies found that lower daily doses of prednisone had the same impact as higher doses, one being a small observational study in Spain and the other being an even smaller trial in Germany. Seeing this data, a team of researchers from the University of Toronto Lupus Clinic reviewed data from their clinic to compare the complete renal response rates of patients treated with medium and high doses of prednisone.

About Lupus Nephritis

Lupus nephritis is a common complication of lupus. In fact, 40% of lupus patients go on to develop LN. In this condition, antibodies attack the part of the kidneys that filter out waste, causing proteinuria, inflammation, hematuria, high blood pressure, and kidney failure in extreme cases. Females and those of African and Asian descent are at a higher risk of developing lupus.

Symptoms specific to lupus nephritis include pain and swelling in the joints, dark and foamy urine, edema, high blood pressure, muscle pain, fever, and rash. The cause is unknown, although medical professionals suspect that it is a combination of genetic and environmental factors. Various lab tests, including urine tests, blood tests, and a kidney biopsy, are used to diagnose this condition. Treatment aims to decrease inflammation, reduce high blood pressure, and suppress the immune system.

About the Study

The research team analyzed a previous study conducted at their clinic, in which 2,050 lupus patients were included in the study, all of whom were followed regularly and checked in every two and six months. For their own analysis, the researchers included 206 participants who had been followed for at least one year before their lupus evolved into LN.

These patients were divided in half, and one group was given a medium dosage (30mg or less daily) while the other was given a high dosage (40mg or more daily). Researchers then followed them for a minimum of one year. Additionally, they defined complete renal response as renal function that does not worsen paired with proteinuria levels under 0.5 g/day. They also looked for any glucocorticoid-related damage in order to best evaluate prednisone as a treatment for LN.

Results include:

  • After one year, the group receiving the higher dose had a 61.8% complete renal response rate
    • The group receiving the medium dose only had a 38.2% complete renal response rate
  • These complete renal response rates rose after two years
    • Higher-dose group saw 67.8% rate
    • Medium-dose group saw 39% rate
  • The rates rose again after three years
    • Higher-dose group saw 64.9% rate
    • Medium-dose group saw 49.1% rate
  • High rate of adverse responses in the group receiving the higher dosage

In the end, the researchers stated that higher doses of prednisone lead to better outcomes and higher complete renal response rates, but it also led to a high rate of adverse responses. They suggest that medical professionals investigate other treatment options for LN, as the adverse responses that come with a high dose of prednisone are too severe.

Find the source article here.

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