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Glucocorticoid toxicity across dose ranges in patients with SLE
Results from a prospective single-center cohort study, evaluating glucocorticoid (GC) toxicity across dose ranges in 302 patients with systemic lupus erythematosus (SLE), were published in Rheumatology and Therapy by Zhang et al. Patients were stratified by average daily prednisone (PDN) dose and assessed using the Glucocorticoid Toxicity Index (GTI), comprising the cumulative worsening score (CWS) and aggregate improvement score (AIS).
Key data: At 1 year, the PDN ≤7.5 mg/day group (n = 223) showed lower median CWS (0 vs 48; p < 0.001) and AIS (0 vs 40; p < 0.001) than the PDN >7.5 mg/day group (n = 79); the highest deterioration rates were in bone health (18.8%) and blood pressure (10.3%). Within the low-dose group, 5<PDN≤7.5 mg/day (n = 52) showed higher toxicity than PDN ≤5 mg/day (n = 171) (CWS, p = 0.002; AIS, p = 0.010). Each 1 mg/day increase in PDN raised median CWS by 3.33 and AIS by 3.42 points.
Key learning: PDN reduction to ≤5 mg/day significantly lowered GC toxicity in SLE; no dose was entirely safe, reinforcing rigorous GC minimization.
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