Lupus & antiphospholipid syndrome
Impact of Glucocorticoid Dose on Complete Response, Serious Infections, and Mortality During the Initial Therapy of Lupus Nephritis: A Systematic Review and Meta‐Analysis of the Control Arms of Randomized Controlled Trials
Authors' conclusion
A higher exposure to glucocorticoids during the initial therapy of LN was associated with better renal outcomes at the cost of increased infections and death.
Study context
- Population
- Patients with biopsy-proven lupus nephritis (LN) in RCT control arms receiving protocolized GC with mycophenolic acid analogs or CYC
- Participants
- 3,231 patients50 RCT arms
- Comparison
- Initial GC regimens with MMF analogs or CYC
- Outcome
- Predicted rates of CR, serious infections and death
Methodological detailsmeta-analysis of proportions, meta-regression, subgroup meta-analysis
- Meta-analysis of proportions
- Meta-regression
- Subgroup meta-analysis
Pooled result
As reported in the abstract
| Group | Value | Serious infections | Death |
|---|---|---|---|
| Prednisone 25 mg/day | 19.5% (95% CI 7.3–31.5) | 3.2% (95% CI 2.4-4.0) | 0.2% (95% CI 0.0-0.4) |
| Prednisone 60 mg/day | 34.6% (95% CI 16.9–52.3) | 12.1% (95% CI 9.3-14.9) | 2.7% (95% CI 0.0-5.3) |
Value
Prednisone 25 mg/day19.5% (95% CI 7.3–31.5)
Prednisone 60 mg/day34.6% (95% CI 16.9–52.3)
Serious infections
Prednisone 25 mg/day3.2% (95% CI 2.4-4.0)
Prednisone 60 mg/day12.1% (95% CI 9.3-14.9)
Death
Prednisone 25 mg/day0.2% (95% CI 0.0-0.4)
Prednisone 60 mg/day2.7% (95% CI 0.0-5.3)
Further pooled results
| Outcome | Prednisone 25 mg/day | Prednisone 60 mg/day |
|---|---|---|
| Serious infections and death (predicted rates)Value = serious infections | 3.2% (95% CI 2.4–4.0) | 12.1% (95% CI 9.3–14.9) |
| Death | 0.2% (95% CI 0.0-0.4) | 2.7% (95% CI 0.0-5.3) |
Adding GC pulses
- Increased the rates of complete response (CR) and death but not serious infections
Dose-response · six months
- Dose-response gradient between initial GC dosage and all outcomes, after accounting for GC pulses, underlying immunosuppressant and baseline proteinuria
Original publication
Impact of Glucocorticoid Dose on Complete Response, Serious Infections, and Mortality During the Initial Therapy of Lupus Nephritis: A Systematic Review and Meta‐Analysis of the Control Arms of Randomized Controlled Trials. Arthritis Rheumatol. Published 28 June 2024. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →