Prednisone, lupus activity, and permanent organ damage

Mae Thamer, Miguel A. Hernán, Yi Zhang, Dennis Cotter, Michelle Petri

Research output: Contribution to journalArticlepeer-review


Objective. To estimate the effect of corticosteroids (prednisone dose) on permanent organ damage among persons with systemic lupus erythematosus (SLE). Methods. We identified 525 patients with incident SLE in the Hopkins Lupus Cohort. At each visit, clinical activity indices, laboratory data, and treatment were recorded. The study population was followed from the month after the first visit until June 29, 2006, or attainment of irreversible organ damage, death, loss to followup, or receipt of pulse methylprednisolone therapy. We estimated the effect of cumulative average dose of prednisone on organ damage using a marginal structural model to adjust for time-dependent confounding by indication due to SLE disease activity. Results. Compared with non-prednisone use, the hazard ratio of organ damage for prednisone was 1.16 (95% CI 0.54, 2.50) for cumulative average doses > 0-180 mg/month, 1.50 (95% CI 0.58, 3.88) for > 180-360 mg/month, 1.64 (95% CI 0.58, 4.69) for > 360-540 mg/month, and 2.51 (95% CI 0.87, 7.27) for > 540 mg/month. In contrast, standard Cox regression models estimated higher hazard ratios at all dose levels. Conclusion. Our results suggest that low doses of prednisone do not result in a substantially increased risk of irreversible organ damage.

Original languageEnglish (US)
Pages (from-to)560-564
Number of pages5
JournalJournal of Rheumatology
Issue number3
StatePublished - Mar 2009


  • Causal modeling
  • Corticosteroid treatment
  • Longterm prednisone therapy
  • Marginal structural model
  • Permanent organ damage
  • Systemic lupus erythematosus

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology


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