OBJECTIVE

This study investigated whether short-term incremental prednisone therapy decreases the risk of relapse without increasing adverse events (AEs) in patients with serologically active, clinically quiescent lupus nephritis (LN).

METHODS

After standardized treatment, 153 patients with serologically active, clinically quiescent LN were included. Clinical data were retrospectively reviewed. The patients were divided into two groups: the control group (n = 58) received prednisone or prednisone and immunosuppressant maintenance therapy, the prednisone increment group (n = 95) received additional prednisone doses of up to 10 mg/day as maintenance therapy, which were then gradually reduced back to the original dose at 3 months. Lupus activity, renal involvement, and AEs during follow-up in the two groups were analyzed within 18 months.

RESULTS

No significant differences in sex, age, disease course, maintenance treatment composition, or laboratory tests between the two groups were observed, except for serum complement C3 levels, which were significantly lower in patients in the prednisone increment group than in controls (P = 0.025). The prednisone increment group had significantly lower recurrence rates than the control group (P = 0.002), with only 3 patients (5.2%) in the prednisone increment group and 24 patients (25.3%) in the control group experiencing relapse. Renal recurrence was significantly lower in the prednisone increase group (P = 0.013). Nine AEs occurred in the prednisone-modulated group and 11 AEs occurred in controls, with infection being the main cause for both groups.

CONCLUSION

Short-term incremental prednisone therapy is safe in reducing recurrence rates in serologically active and clinically quiescent patients with LN. Key points Incremental prednisone is safe and effective for patients with serologically active clinically quiescent LN.