Predictors of corticosteroid tapering in SLE patients: The Hopkins Lupus Cohort

Z. Abou Zahr, H. Fang, L. S. Magder, Michelle Petri

Research output: Contribution to journalArticle

Abstract

Purpose: Organ damage in systemic lupus erythematosus (SLE) patients is highly associated with the use of corticosteroids. Doses of prednisone below 6mg daily are associated with reduced organ damage. We now report on the largest prospective cohort study of predictors of prednisone tapering in SLE patients. Methods: 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 patients 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. Result: 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. Conclusion: Our study suggests that successful tapering of prednisone below 5mg 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.

Original languageEnglish (US)
Pages (from-to)697-701
Number of pages5
JournalLupus
Volume22
Issue number7
DOIs
StatePublished - Jun 2013

Fingerprint

Systemic Lupus Erythematosus
Adrenal Cortex Hormones
Prednisone
Education
Proteinuria
African Americans
Arthritis
Cohort Studies
Demography
Urine
Prospective Studies
Skin

Keywords

  • corticosteroids
  • organ damage
  • SLE
  • SLEDAI

ASJC Scopus subject areas

  • Rheumatology

Cite this

Predictors of corticosteroid tapering in SLE patients : The Hopkins Lupus Cohort. / Zahr, Z. Abou; Fang, H.; Magder, L. S.; Petri, Michelle.

In: Lupus, Vol. 22, No. 7, 06.2013, p. 697-701.

Research output: Contribution to journalArticle

Zahr, Z. Abou ; Fang, H. ; Magder, L. S. ; Petri, Michelle. / Predictors of corticosteroid tapering in SLE patients : The Hopkins Lupus Cohort. In: Lupus. 2013 ; Vol. 22, No. 7. pp. 697-701.
@article{89001f2ae2ad43bb9333447a8e93d3ee,
title = "Predictors of corticosteroid tapering in SLE patients: The Hopkins Lupus Cohort",
abstract = "Purpose: Organ damage in systemic lupus erythematosus (SLE) patients is highly associated with the use of corticosteroids. Doses of prednisone below 6mg daily are associated with reduced organ damage. We now report on the largest prospective cohort study of predictors of prednisone tapering in SLE patients. Methods: 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 patients 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. Result: 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. Conclusion: Our study suggests that successful tapering of prednisone below 5mg 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.",
keywords = "corticosteroids, organ damage, SLE, SLEDAI",
author = "Zahr, {Z. Abou} and H. Fang and Magder, {L. S.} and Michelle Petri",
year = "2013",
month = "6",
doi = "10.1177/0961203313490434",
language = "English (US)",
volume = "22",
pages = "697--701",
journal = "Lupus",
issn = "0961-2033",
publisher = "SAGE Publications Ltd",
number = "7",

}

TY - JOUR

T1 - Predictors of corticosteroid tapering in SLE patients

T2 - The Hopkins Lupus Cohort

AU - Zahr, Z. Abou

AU - Fang, H.

AU - Magder, L. S.

AU - Petri, Michelle

PY - 2013/6

Y1 - 2013/6

N2 - Purpose: Organ damage in systemic lupus erythematosus (SLE) patients is highly associated with the use of corticosteroids. Doses of prednisone below 6mg daily are associated with reduced organ damage. We now report on the largest prospective cohort study of predictors of prednisone tapering in SLE patients. Methods: 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 patients 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. Result: 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. Conclusion: Our study suggests that successful tapering of prednisone below 5mg 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.

AB - Purpose: Organ damage in systemic lupus erythematosus (SLE) patients is highly associated with the use of corticosteroids. Doses of prednisone below 6mg daily are associated with reduced organ damage. We now report on the largest prospective cohort study of predictors of prednisone tapering in SLE patients. Methods: 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 patients 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. Result: 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. Conclusion: Our study suggests that successful tapering of prednisone below 5mg 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.

KW - corticosteroids

KW - organ damage

KW - SLE

KW - SLEDAI

UR - http://www.scopus.com/inward/record.url?scp=84879210367&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84879210367&partnerID=8YFLogxK

U2 - 10.1177/0961203313490434

DO - 10.1177/0961203313490434

M3 - Article

C2 - 23708944

AN - SCOPUS:84879210367

VL - 22

SP - 697

EP - 701

JO - Lupus

JF - Lupus

SN - 0961-2033

IS - 7

ER -