Comparable 12-month renal response outcomes with medium- vs high-dose starting prednisone in a real-world study of Lupus Nephritis
Year: 2025
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: The optimal starting dose and tapering of glucocorticoids (GC) in LN remains unknown. We aimed to assess whether a higher prednisone dose results in better 12-month complete renal response (CRR) rates compared with a lower dose, in a contemporary multicentre cohort of LN patients. METHODS: Retrospective and prospective cohort study of patients with new-onset biopsy-proven LN (period 2014-to date). Overall and complete renal response rates at 12 months were compared between patients who started with high (>40 mg/day) vs low-medium (≤40 mg/day) prednisone dose. Multivariable regression and time-to-response analyses were performed, applying inverse probability of treatment weighting (IPTW) to balance baseline covariates and minimize confounding. RESULTS: A total of 162 patients were included; 101 received a low-medium starting prednisone dose (median 30 mg/day) and 61 received a high dose (median 60 mg/day). Cumulative prednisone exposure in the first year was significantly higher in the high-dose group (6.9 g vs 4.0 g; P < 0.001), although cumulative doses equalized by years 2 and 3. The 12-month CRR rates were comparable between the high- and medium-dose groups (65.4% in the low-medium vs 71.2% in the high-dose group, P = 0.55). In multivariable logistic regression with IPTW, a higher initial prednisone dose was not associated with better CRR rate (adjusted OR 1.00; 95% CI: 0.46-2.22). Similarly, time-to-response analyses showed no difference in achieving overall renal response (log-rank P = 0.26). CONCLUSION: Despite significantly increasing GC exposure, a higher starting prednisone dose was not associated with improved renal response rates at 12 months in a contemporary LN cohort.
Source: Lara D. Veeken
Authors: Maria Pappa, Sofia Flouda, Antigone Pieta, Spyridon Katechis, Myrto Nikoloudaki, Nektarios-Marios Liapis, Christina Tsalapaki, Aglaia Chalkia, Evangelia Argyriou, Theodoros Dimitroulas, Myrto Cheila, Charalampos Papagoras, Andreas V Goules, Christina Katsiari, Dimitrios Vassilopoulos, Prodromos Sidiropoulos, Kyriaki A Boki, Petros P Sfikakis, George Liapis, Charikleia Gakiopoulou, Foteini Karasavvidou, Paraskevi V Voulgari, Dimitrios Boumpas, George K Bertsias, Maria G Tektonidou, Antonis Fanouriakis
Institutions: National and Kapodistrian University of Athens, University General Hospital Attikon, University of Ioannina, University of Crete, University Hospital of Larissa, General Hospital of Larisa, Greece, Hippocration General Hospital, Sismanoglio General Hospital, Aristotle University of Thessaloniki, Ippokrateio General Hospital of Thessaloniki, Evangelismos Hospital, Democritus University of Thrace, University Hospital of Alexandroupolis, Laiko General Hospital of Athens, University of Thessaly
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,597
OpenAlex ID: W4415719863