A study led by Krembil researchers reveals that currently recommended doses of the steroid medication prednisone are more effective at treating the disease than lower doses.
Prednisone is the most common drug prescribed to treat lupus nephritis—an autoimmune disease in which the body’s immune system attacks the kidney. The disease causes inflammation at sites in the kidney—known as glomeruli—that filter and cleanse the blood.
Because steroid drugs can cause a number of serious side effects, such as cataracts, diabetes and osteoporosis, efforts are underway to minimize the amount of prednisone that is prescribed to individuals with lupus. Two recent studies have suggested that low doses of the drug might be effective at treating lupus nephritis.
“These studies were preliminary. They enrolled very few participants and did not fully establish the link between drug dose and symptom improvement, so we saw the need for a larger and more thorough investigation,” says Dr. Murray Urowitz, senior author of the study and Senior Scientist at UHN’s Schroeder Arthritis Institute.
Working with a team of Krembil researchers that included Senior Scientist Dafna Gladman, Dr. Urowitz led a study involving 206 individuals with lupus nephritis. The researchers split the participants into two groups based on their prednisone dose: a medium dose group (30 mg/day or less) and a high dose group (40 mg/day or more). The two groups were matched for demographic features, lupus disease factors and other therapies used.
The study followed the patients over three years. As is standard for treatment with prednisone, doses were lowered over time. The dose reductions were not the same for both groups: the drug levels in high dose group were lowered to a greater extent so that, by one year after the start of treatment, prednisone levels were lower in this group than in the original medium dose group.
The results revealed that around 62% of individuals in the high dose group experienced complete remission (i.e., disappearance of the signs of disease) at the one-year mark—versus only around 38% in the medium dose group. Furthermore, there was no difference observed between the two groups in terms of harmful side effects.
“Our findings reveal that high prednisone doses—40 mg or more per day—within the first six months are beneficial for treating lupus nephritis, and that lower doses do not provide additional benefits or fewer side effects,” concludes Dr. Urowitz.
This work was supported by the Canadian Institutes of Health Research, the Lou and Marissa Rocca Family, the Mark and Diana Bozzo Family, Lupus Canada and the UHN Foundation.
Tselios K, Gladman DD, Al-Sheikh H, Su J, Urowitz MB. Medium versus high initial prednisone dose for remission induction in lupus nephritis: A propensity score matched analysis. Arthritis Care Res (Hoboken). 2021 Mar 4. doi: 10.1002/acr.24592.
Dr. Murray Urowitz, lead author of the study and Senior Scientist at the Schroeder Arthritis Institute.
In the kidney, glomeruli serve as microscopic filters: blood (red arrow) enters the glomerulus and is filtered through a tightly packed network of vessels to produce urine (yellow), which flows to the bladder.