Low-dose steroid may be effective in lupus nephritis
A low-dose prednisolone regimen may be effective in patients with proliferative lupus nephritis (LN), resulting in lower steroid dose-related side effects and infection rates compared with a conventional high-dose regimen, according to a study.
In this open-label randomized clinical trial, 32 patients with LN were randomized to receive low-dose prednisolone or high-dose prednisolone. All patients received the standard dose of intravenous (I/V) methylprednisolone and pulse I/V cyclophosphamide, with the low-dose group receiving 0.5 mg/kg oral prednisolone daily and the high-dose group receiving 1 mg/kg oral prednisolone daily for 4 weeks before being tapered. Patients were followed for 24 weeks.
Both groups had a complete renal remission rate of 66.7%. Patients in the prednisolone low-dose group had a renal remission (partial/complete) of 86.7%, while the high-dose group had a rate of 83.3%. No significant difference between the groups was observed in the improvement of active urinary sediments, serum creatinine level, anti-double-stranded DNA level, complements level, disease activity, and Short Form-12 score.
There were more prednisolone dose-related adverse events and serious adverse events reported in the high-dose prednisolone group.
Bandhan IH, Islam MN, Ahmad HI, et al. Outcome of low-dose prednisolone use for the induction of remission in lupus nephritis patients. Int J Rheum Dis. 2021;doi: 10.1111/1756-185X.14265. Epub ahead of print. PMID: 34894070.