Ruiz-Irastorza, GGarcia, MEspinosa, GCaminal, LMitjavila, FGonzález-León, RSopeña, BCanora, JVillalba, M VRodríguez-Carballeira, MLópez-Dupla, J MCallejas, J LCastro, ATolosa, CSánchez-García, M EPérez-Conesa, MNavarrete-Navarrete, NRodríguez, A PHerranz, M TPallarés, L2016-10-272016-10-272016-08-16Ruiz-Irastorza G, Garcia M, Espinosa G, Caminal L, Mitjavila F, González-León R, et al. First month prednisone dose predicts prednisone burden during the following 11 months: an observational study from the RELES cohort. Lupus Sci Med. 2016; 3(1):e000153http://hdl.handle.net/10668/2498Journal Article;AIM To study the influence of prednisone dose during the first month after systemic lupus erythematosus (SLE) diagnosis (prednisone-1) on glucocorticoid burden during the subsequent 11 months (prednisone-2-12). METHODS 223 patients from the Registro Español de Lupus Eritematoso Sistémico inception cohort were studied. The cumulative dose of prednisone-1 and prednisone-2-12 were calculated and recoded into a four-level categorical variable: no prednisone, low dose (up to 7.5 mg/day), medium dose (up to 30 mg/day) and high dose (over 30 mg/day). The association between the cumulative prednisone-1 and prednisone-2-12 doses was tested. We analysed whether the four-level prednisone-1 categorical variable was an independent predictor of an average dose >7.5 mg/day of prednisone-2-12. Adjusting variables included age, immunosuppressives, antimalarials, methyl-prednisolone pulses, lupus nephritis and baseline SLE Disease Activity Index (SLEDAI). RESULTS Within the first month, 113 patients (51%) did not receive any prednisone, 24 patients (11%) received average low doses, 46 patients (21%) received medium doses and 40 patients (18%) received high doses. There was a strong association between prednisone-1 and prednisone-2-12 dose categories (p<0.001). The cumulative prednisone-1 dose was directly associated with the cumulative prednisone-2-12 dose (p<0.001). Compared with patients on no prednisone, patients taking medium (adjusted OR 5.27, 95% CI 2.18 to 12.73) or high-dose prednisone-1 (adjusted OR 10.5, 95% CI 3.8 to 29.17) were more likely to receive prednisone-2-12 doses of >7.5 mg/day, while patients receiving low-dose prednisone-1 were not (adjusted OR 1.4, 95% CI 0. 0.38 to 5.2). If the analysis was restricted to the 158 patients with a baseline SLEDAI of ≥6, the model did not change. CONCLUSION The dose of prednisone during the first month after the diagnosis of SLE is an independent predictor of prednisone burden during the following 11 months.enAntimaláricosGlucocorticoidesHumanosInmunosupresoresLupus eritematoso discoideLupus eritematoso sistémicoNefritis lúpicaMetilprednisolonaPrednisonaPulso arterialMedical Subject Headings::Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Antiparasitic Agents::Antiprotozoal Agents::AntimalarialsMedical Subject Headings::Chemicals and Drugs::Hormones, Hormone Substitutes, and Hormone Antagonists::Hormones::Adrenal Cortex Hormones::GlucocorticoidsMedical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::HumansMedical Subject Headings::Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Physiological Effects of Drugs::Immunologic Factors::Immunosuppressive AgentsMedical Subject Headings::Diseases::Skin and Connective Tissue Diseases::Connective Tissue Diseases::Lupus Erythematosus, Cutaneous::Lupus Erythematosus, DiscoidMedical Subject Headings::Diseases::Skin and Connective Tissue Diseases::Connective Tissue Diseases::Lupus Erythematosus, SystemicMedical Subject Headings::Diseases::Skin and Connective Tissue Diseases::Connective Tissue Diseases::Lupus Erythematosus, Systemic::Lupus NephritisMedical Subject Headings::Chemicals and Drugs::Polycyclic Compounds::Steroids::Pregnanes::Pregnadienes::Pregnadienetriols::Prednisolone::MethylprednisoloneMedical Subject Headings::Chemicals and Drugs::Polycyclic Compounds::Steroids::Pregnanes::Pregnadienes::Pregnadienediols::PrednisoneMedical Subject Headings::Phenomena and Processes::Circulatory and Respiratory Physiological Phenomena::Cardiovascular Physiological Phenomena::Hemodynamics::Pulseresearch article27547439open access10.1136/lupus-2016-0001532053-8790PMC4985804