Prednisone, Lupus Activity, and Permanent Organ Damage

Article Figures & Data

Table 1.

Demographic and clinical characteristics of study population (n = 525).

Characteristic	n	(%)
Sex
F	472	(89.9)
M	53	(10.1)
Race/ethnicity
Caucasian	294	(56.0)
African American	196	(37.3)
Other	35	(6.7)
Age at SLE diagnosis, yrs
10 to 25	113	(21.5)
26 to 40	230	(43.8)
41 to 76	182	(34.7)
Year of SLE diagnosis
Before 1990	64	(12.2)
1990 to 1999	236	(45.0)
2000 to 2006	225	(42.9)
Prednisone dose at first visit, mg/mo
0	254	(48.4)
> 0–180	62	(11.8)
> 180–360	48	(9.1)
> 360–540	34	(6.5)
> 540	127	(24.2)
Lupus disease activity at first visit (SLEDAI score)
0	153	(29.1)
1 to 2	137	(26.1)
3 to 4	112	(21.3)
≥ 5	123	(23.4)
Organ damage score at first visit S (DI index)
0	318	(60.6)
1	118	(22.5)
2	52	(9.9)
≥ 3	37	(7.0)

SLEDAI: Systemic Lupus Erythematosus Disease Activity Index; SDI: Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index.

Table 2.

Percentage of patients by cumulative prednisone dose by duration of SLE

Cumulative Prednisone Dose (mg/mo)	Years After First Visit for SLE
Cumulative Prednisone Dose (mg/mo)	1	3	5	10
0	45.7 (0)	30.6 (0)	28.1 (0)	15.4 (0)
> 0–180	15.1 (0–2.2)	34.7 (0–6.5)	40.4 (0–10.8)	57.7 (0–21.6)
> 180–360	17.8 (2.2–4.3)	19.4 (6.5–14.0)	21.1 (10.8–21.6)	23.1 (21.6–43.2)
> 360–540	8.9 (4.3–6.5)	9.9 (14.0–19.0)	8.8 (21.6–32.4)	3.9 (43.2–64.8)
> 540	12.6 (> 6.5)	5.4 (> 19)	1.8 (> 32.4)	0 (> 64.8)
No. of patients	438	222	114	26

Table 4.

Hazard ratio of organ damage (n = 141) by cumulative average dose of prednisone.

Cumulative Average Prednisone			Unadjusted Model		Conventionally-Adjusted Model^*		Weighted Model^*
Dose (mg/mo)	% of Patient-mos	No. of Events	HR	95% CI	HR	95% CI	HR	95% CI
0	35.9	34	Ref		Ref		Ref
> 0–180	37.0	49	1.58	1.00, 2.50	2.01	1.11, 3.63	1.16	0.54, 2.50
> 180–360	14.9	29	2.10	1.24, 3.55	2.46	1.17, 5.16	1.50	0.58, 3.88
> 360–540	6.7	18	3.04	1.67, 5.53	3.54	1.55, 8.12	1.64	0.58, 4.69
> 540	5.5	21	4.19	2.35, 7.47	4.10	1.74, 9.65	2.51	0.87, 7.27

↵* Adjusted for age, sex, race/ethnicity, baseline prednisone dose, baseline SLE activity, baseline organ damage, and time-varying covariates. HR: hazard ratio.

Table 5.

Secondary analyses estimating hazard ratio (HR) of organ damage by cumulative prednisone dose.

	Unadjusted Model		Conventionally-adjusted Model		Weighted Model
	HR	95% CI	HR	95% CI	HR	95% CI
Cumulative average prednisone dose (outcome death or organ damage) (mg/mo)
0 dose	Ref		Ref		Ref
> 0–180	1.44	0.92, 2.24	1.78	1.00, 3.18	1.06	0.50, 2.26
> 180–360	2.13	1.29, 3.51	2.39	1.17, 4.87	1.53	0.60, 3.90
> 360–540	2.93	1.64, 5.21	3.33	1.49, 7.47	1.58	0.56, 4.45
> 540	4.22	2.43, 7.32	4.08	1.78, 9.34	2.63	0.94, 7.36
Average 3-month prednisone dose (censoring at pulse methylprednisolone therapy)^† m (g/mo)
0 dose	Ref		Ref		Ref
> 0–180	1.73	1.01, 2.95	1.45	0.81, 2.59	1.14	0.57, 2.28
> 180–360	2.28	1.22, 4.25	1.83	0.95, 3.50	1.67	0.73, 3.85
> 360–540	1.57	0.64, 3.86	1.24	0.49, 3.16	0.91	0.31, 2.67
> 540	3.02	1.44, 6.33	2.61	1.19, 5.72	2.20	0.89, 5.43
Cumulative average prednisone dose (controlling for pulse methylprednisolone therapy)^* (mg/mo)
0 dose	Ref		Ref		Ref
> 0–180	1.44	0.93, 2.24	1.78	1.01, 3.16	1.01	0.47, 2.15
> 180–360	1.93	1.16, 3.22	2.24	1.09, 4.59	1.21	0.46, 3.15
> 360–540	2.87	1.61, 5.11	3.49	1.56, 7.78	1.51	0.54, 4.21
> 540	4.24	2.44, 7.35	4.36	1.90, 9.99	2.49	0.85, 7.30