Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
Lupus. 2013 Jun;22(7):697-701. doi: 10.1177/0961203313490434. Epub 2013 May 24.
Organ damage in systemic lupus erythematosus (SLE) patients is highly associated with the use of corticosteroids. Doses of prednisone below 6 mg daily are associated with reduced organ damage. We now report on the largest prospective cohort study of predictors of prednisone tapering in SLE patients.
A total of 866 SLE patients (91% female, 50% Caucasian, 43% African-American, mean age 43 years) who consented for the Hopkins Lupus Cohort from 1987 through 2009 were included. The analysis was based on patient visits in which the previously prescribed dose of prednisone was 5 mg/day. We then examined the proportion of times the patient's dose was reduced to below 5 mg/day ("tapering"). Among those patients who tapered and were followed for at least one year thereafter, we examined the proportion whose prednisone dose remained below 5 mg/day for at least one year ("Successful tapering"). Rates of tapering and successful tapering were calculated for patient subsets based on demographic and clinical characteristics.
The analyses showed that Caucasians, younger patients, patients with a higher level of education, lower disease activity, or absence of urine protein were more likely to have a prednisone taper. However, successful tapering was not dependent on age, ethnicity, or education. As expected, successful tapering was more frequent in those with lower disease activity. Successful tapering was achieved more often after the year 2000.
Our study suggests that successful tapering of prednisone below 5 mg has increased since the year 2000, which may reflect the greater knowledge of the long-term harm of even low-dose chronic corticosteroid use. Caucasians, younger age, higher level of education, and absence of proteinuria predicted tapering, but not successful tapering. Ongoing cutaneous or arthritis activity were associated with unsuccessful tapering. Lack of disease activity, as expected, was the only major clinical variable that significantly predicted successful tapering.
系统性红斑狼疮（SLE）患者的器官损伤与皮质类固醇的使用高度相关。每日泼尼松剂量低于 6 毫克与器官损伤减少相关。我们现在报告 SLE 患者泼尼松减量的最大前瞻性队列研究预测因子。
共有 866 名 SLE 患者（91%为女性，50%为白种人，43%为非裔美国人，平均年龄 43 岁），自 1987 年至 2009 年同意加入霍普金斯狼疮队列。分析基于患者就诊时的情况，即之前规定的泼尼松剂量为 5 毫克/天。然后，我们检查了患者剂量减少至 5 毫克/天以下的次数比例（“减量”）。在那些减量并在此后至少随访一年的患者中，我们检查了泼尼松剂量至少在一年保持在 5 毫克/天以下的比例（“成功减量”）。根据人口统计学和临床特征，对患者亚组计算减量和成功减量的比例。
分析表明，白种人、年轻患者、受教育程度较高、疾病活动度较低或无尿蛋白的患者更有可能进行泼尼松减量。然而，成功减量并不依赖于年龄、种族或教育程度。正如预期的那样，疾病活动度较低的患者更频繁地成功减量。成功减量在 2000 年后更为常见。
我们的研究表明，自 2000 年以来，成功将泼尼松减量至 5 毫克以下的情况有所增加，这可能反映了即使是低剂量慢性皮质类固醇使用的长期危害的认识增加。白种人、年龄较小、受教育程度较高和无蛋白尿预测减量，但不能预测成功减量。持续的皮肤或关节炎活动与减量失败相关。如预期的那样，缺乏疾病活动是唯一显著预测成功减量的主要临床变量。
