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

Author:

Figueroa‐Parra Gabriel1ORCID,Cuéllar‐Gutiérrez María C.2ORCID,González‐Treviño Mariana1ORCID,Sanchez‐Rodriguez Alain1ORCID,Flores‐Gouyonnet Jaime1ORCID,Meade‐Aguilar José A.3ORCID,Prokop Larry J.1ORCID,Murad M. Hassan1,Dall'Era María4ORCID,Rovin Brad H.5ORCID,Houssiau Frédéric6ORCID,Tamirou Farah6,Fervenza Fernando C.1ORCID,Crowson Cynthia S.1ORCID,Putman Michael S.7,Duarte‐García Alí1ORCID

Affiliation:

1. Mayo Clinic Rochester Minnesota

2. Mayo Clinic, Rochester, Minnesota, and Hospital del Salvador Santiago Chile

3. Mayo Clinic, Rochester, Minnesota, and Boston University Chobanian & Avedisian School of Medicine Boston Massachusetts

4. University of California San Francisco

5. Ohio State University Wexner Medical Center Columbus

6. Cliniques Universitaires Saint‐Luc, Université Catholique de Louvain Brussels Belgium

7. Medical College of Wisconsin Milwaukee

Abstract

ObjectiveOur objective was to evaluate the effect of glucocorticoid regimens on renal response, infections, and mortality among patients with lupus nephritis (LN).MethodsWe performed a systematic review and meta‐analysis of the control arms of randomized clinical trials (RCTs). We included RCTs of biopsy‐proven LN that used a protocolized regimen of glucocorticoids in combination with mycophenolic acid analogs or cyclophosphamide and reported the outcomes of complete response (CR), serious infections, and death. The starting dosage of glucocorticoids, tapering method, and administration of glucocorticoid pulses were abstracted. Meta‐analysis of proportions, meta‐regression, and subgroup meta‐analysis were performed at 6 and 12 months for all outcomes.ResultsFifty RCT arms (3,231 patients with LN) were included. The predicted rates of CR, serious infections, and death when starting on oral prednisone at 25 mg/day without pulses were 19.5% (95% confidence interval [CI] 7.3–31.5), 3.2% (95% CI 2.4–4.0), and 0.2% (95% CI 0.0–0.4), respectively. Starting on prednisone at 60 mg/day (without pulses) increased the rates to 34.6% (95% CI 16.9–52.3), 12.1% (95% CI 9.3–14.9), and 2.7% (95% CI 0.0–5.3), respectively. Adding glucocorticoid pulses increased the rates of CR and death but not serious infections. We observed a dose–response gradient between the initial glucocorticoid dosage and all the outcomes at six months after accounting for the administration of glucocorticoid pulses, underlying immunosuppressant, and baseline proteinuria.ConclusionA higher exposure to glucocorticoids during the initial therapy of LN was associated with better renal outcomes at the cost of increased infections and death.

Funder

Rheumatology Research Foundation

Publisher

Wiley

Cited by 1 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Lupus Nephritis from Pathogenesis to New Therapies: An Update;International Journal of Molecular Sciences;2024-08-18

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