Larger doses of the corticosteroid prednisone increased the risk of developing organ damage in patients with systemic lupus erythematosus (SLE), according to a analysis of the Hopkins Lupus Cohort.
The risk of developing organ damage more than doubled in patients exposed to a mean prior prednisone dose that was ≥ 20 mg/day, compared with one that was < 7.5 mg/day.
Increasing the dose of prednisone also was correlated with an increased risk of various organ systems being damaged. Specifically, past mean doses of at least 7.5 mg/day of the corticosteroid significantly increased the risk of developing cataracts, osteoporotic fractures, and cardiovascular damage. Of the total number of organ damage events that occurred, 13.7% were cataracts, 12.4% were osteoporotic fractures, and 9% were cardiovascular damage. The most first-time organ damage events occurred within the musculoskeletal and ocular organ systems, suggesting that “these corticosteroid-related comorbidities might present prior to any other type of organ damage in patients with SLE,” according to Sarah Al Sawah, Ph.D., and her colleagues.
In addition to mean prednisone use, recent disease activity, immunosuppressant use during follow-up, and extent of organ damage at cohort entry were significant predictors of organ damage.
“Overall, this study confirmed what has been previously reported on the increased risk of irreversible organ damage associated with corticosteroid use in SLE,” the researchers wrote. The study was funded by Eli Lilly, and the authors are employed by the company.
Find the full study in: BMJ 2015 (doi:10.1136/lupus-2014-000066).