Upside/Downside of Steroids in Lupus Nephritis Save

A systematic review of randomized clinical trials of patients with biopsy-proven lupus nephritis (LN) demonstrates both the benefits and harms to early glucocorticoid (GC) regimens on lupus outcomes. 

This meta-analysis of the control arms of 50 RCTs of 3231 LN patients using protocolized GC (along with mycophenolic acid or cyclophosphamide) examined GC use and LN complete response (CR), serious infections, or death after six and twelve months of GC use.

Here are the outcomes based on Starting prednisone doses:

• Oral prednisone 25mg/day (without pulses)
  • CR: 19.5% 
  • Serious infections 3.2% 
  • Death 0.2% 
• Oral prednisone 60 mg/day (without pulses) increased these rates to:
  • CR 34.6% 
  • Serious infection 12.1% 
  • Death 2.7% 

Adding glucocorticoid pulses increased the CR and death rates, but not serious infections. 

While increasing the GC dose in treating lupus nephritis may initially yield better better renal outcomes, it may also increase the odds of  infections and mortality.

Higher efficacy comes may yield increasing toxicity with GC use; thus the need to individualize the benefit to risk considerations in lupus patient management.