Researchers at the Hopkins Lupus Center at Johns Hopkins University School of Medicine recently found that corticosteroids can be effective in fighting inflammations associated with lupus. However, according to the new study, adverse events from high doses can damage organs. These new findings may guide clinicians on the optimal dosing of corticosteroids in patients with lupus. The study is published in the journal Lupus Science & Medicine™, the official journal of Lupus Foundation of America.
Reduction of corticosteroid dose remains an important goal in the management of systemic lupus erythematosus (SLE). Chronic corticosteroid use is associated with the accrual of irreversible organ damage over time, with the highest risk being among those exposed to a mean prednisone dose of ≥20 mg/day. Evidence from recent studies support a significant association between corticosteroid use and the risk of developing new cardiovascular damage over time, while controlling for important clinical measures including disease activity, as well as traditional risk factors of cardiovascular diseases.
In the study titled “Effect of corticosteroid use by dose on the risk of developing organ damage over time in systemic lupus erythematosus—the Hopkins Lupus Cohort,” Michelle Petri, MD and her colleagues sought to understand the association between corticosteroid use by dose and the accrual of organ damage overall and organ damage of individual organ systems over time in order to estimate the long-term benefit gained from the use of corticosteroid-sparing therapies, beyond the benefit gained from controlled disease activity.
Using the most recent analysis from the lupus study, the researchers found that the mean prior prednisone dose, recent disease activity and immunosuppressant use during follow-up, as well as organ damage score at cohort entry, were all significant independent predictors of the risk of developing any new organ damage.
The research team was also able to identify an organ damage risk associated with exposure to high-dose prednisone over time (i.e., ≥7.5 mg/day). The results also provided a further understanding of the risk imposed by an average of a 1 mg/day or 5 mg/day increase in prednisone dose. According to the authors this could help clinicians to better understand the long-term benefit gained from the use of corticosteroid-sparing therapies that are currently in development in SLE clinical trials.