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, M.
N1 - Funding Information:
The Hopkins Lupus Cohort is supported by the National Institutes of Health (NIH) AR43727 grant.
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 - SLE
KW - SLEDAI
KW - corticosteroids
KW - organ damage
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U2 - 10.1177/0961203313490434
DO - 10.1177/0961203313490434
M3 - Article
C2 - 23708944
AN - SCOPUS:84879210367
SN - 0961-2033
VL - 22
SP - 697
EP - 701
JO - Lupus
JF - Lupus
IS - 7
ER -