Low Dose of Prednisone May be Better than Complete Withdrawal While Lupus is Inactive
New research found that people with lupus whose disease is in remission for at least one year, and who are at high risk of relapse, benefit from a continued low dose (5mg.) of Prednisone versus complete withdrawal of the therapy. Complete withdrawal of Prednisone was associated with a fourfold increase in the risk of flare. Maintenance of the drug with inactive disease prevents relapse or flares.
In this CORTICOLUP study, researchers investigated the long-term use of low-dose glucocorticoids (Prednisone) in people with lupus. A group of 124 people in remission on treatment were monitored, with 61 people receiving a maintained dose of 5mg. and 63 people completely withdrawn from the medication. Using several lupus disease activity measurement models – SELENA-SLEDAI flare index (SFI), British Isles Lupus Assessment Group (BILAG) index, Systemic Lupus International Collaborating Clinics (SLICC) damage index (SDI) – at 52 weeks, people in the maintenance group saw minimal disease activity versus the withdrawal group. Additionally, three people in the withdrawal group reported damage-related events (osteoporosis-related fractures, retinal toxicity, cataract) and zero events were recorded in the maintenance group.
"Systemic lupus erythematosus (SLE) is a chronic relapsing-remitting disease. An active disease-free state is generally maintained by long-term medications. However, the duration and dose of glucocorticoids (GC), hydroxychloroquine (HCQ) and immunosuppressant (IS) therapy, after achievement of disease remission, remain undefined and it is only with medication tapering that the physician is able to determine whether the disease was truly in remission or maintained in remission as a result of medication," shared study author Zahir Amoura, MD, MSc
This study provides further insight into glucocorticoids therapy and the possibility of continuing 5 mg. Prednisone at long course to avoid disease activity. While Prednisone is an effective and rapid anti-inflammatory agent in lupus, side effects of higher doses of the medication can be significant over time. Learn about the side effects of corticosteroids.