RT Journal Article
SR Electronic
T1 Prednisone, Lupus Activity, and Permanent Organ Damage
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP jrheum.080828
DO 10.3899/jrheum.080828
A1 Mae Thamer
A1 Miguel A. Hernán
A1 Yi Zhang
A1 Dennis Cotter
A1 Michelle Petri
YR 2009
UL http://www.jrheum.org/content/early/2009/02/04/jrheum.080828.abstract
AB 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 followup, 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. Conclusion Our results suggest that low doses of prednisone do not result in a substantially increased risk of irreversible organ damage.