Scholarlink

Introduction <p>Despite the European Alliance of Associations for Rheumatology (EULAR) recommendation to minimize glucocorticoid (GC) use in systemic lupus erythematosus (SLE), prospective data quantifying toxicity across low-dose ranges are lacking. This study aimed to assess toxicity using the GC toxicity index (GTI) in SLE patients and compare toxicity profiles among dose-defined subgroups.</p> Methods <p>Patients from the STAR cohort (May 2023–May 2024) were prospectively followed up for 1&#xa0;year. Stratified by average daily prednisone (PDN) dose, toxicity was assessed using GTI comprising the aggregate improvement score (AIS) and the cumulative worsening score (CWS) at baseline and 1&#xa0;year. Three pre-planned stepwise comparisons used dose thresholds of 7.5&#xa0;mg, 5&#xa0;mg, and 2.5&#xa0;mg, with a Bonferroni-corrected significance level of <i>P</i> &lt; 0.0167 (<i>α</i> = 0.05/3). Quantile regression evaluated the association between average daily PDN dose and CWS/AIS.</p> Results <p>Of 302 patients, the PDN ≤ 7.5&#xa0;mg/day group (<i>n</i> = 223) showed statistically lower median CWS [0 (IQR 0–19) vs. 48 (IQR 19–84), <i>P</i> &lt; 0.001] and AIS [0 (IQR − 19–10) vs. 40 (IQR 9–74), <i>P</i> &lt; 0.001] compared to the PDN &gt; 7.5&#xa0;mg/day group (<i>n</i> = 79). Within the low-dose group, patients with 5 &lt; PDN ≤ 7.5&#xa0;mg/day (<i>n</i> = 52) exhibited higher median CWS [10.5 (IQR 0–29) vs. 0 (IQR 0–19), <i>P</i> = 0.002] and wider AIS interquartile range [0 (IQR − 18.75–29) vs. 0 (IQR − 20–0), <i>P</i> = 0.010] than the PDN ≤ 5&#xa0;mg/day subgroup (<i>n</i> = 171). No significant differences in CWS or AIS were observed between the PDN ≤ 2.5&#xa0;mg/day (<i>n</i> = 90) and 2.5 &lt; PDN ≤ 5&#xa0;mg/day (<i>n</i> = 81) subgroups. Quantile regression indicated that each 1&#xa0;mg/day increase in PDN dose raised median CWS by 3.33 points and median AIS by 3.42 points.</p> Conclusions <p>To our knowledge, this study provided the first prospective and quantitative evidence using the GTI to demonstrate that PDN dose reduction to ≤ 5&#xa0;mg/day was linked to reduced toxicity. Moreover, we found that no dose was entirely safe, which strongly supported the EULAR strategy of rigorous GC minimization.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Prospective Quantification of Glucocorticoid Toxicity Across Dosage Ranges in Systemic Lupus Erythematosus: Insights from the Glucocorticoid Toxicity Index

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年4月28日

查看全文
  • Jiaying Zhang,
  • Dai Gao,
  • Yong Fan,
  • Zhuoli Zhang

摘要

Introduction

Despite the European Alliance of Associations for Rheumatology (EULAR) recommendation to minimize glucocorticoid (GC) use in systemic lupus erythematosus (SLE), prospective data quantifying toxicity across low-dose ranges are lacking. This study aimed to assess toxicity using the GC toxicity index (GTI) in SLE patients and compare toxicity profiles among dose-defined subgroups.

Methods

Patients from the STAR cohort (May 2023–May 2024) were prospectively followed up for 1 year. Stratified by average daily prednisone (PDN) dose, toxicity was assessed using GTI comprising the aggregate improvement score (AIS) and the cumulative worsening score (CWS) at baseline and 1 year. Three pre-planned stepwise comparisons used dose thresholds of 7.5 mg, 5 mg, and 2.5 mg, with a Bonferroni-corrected significance level of P < 0.0167 (α = 0.05/3). Quantile regression evaluated the association between average daily PDN dose and CWS/AIS.

Results

Of 302 patients, the PDN ≤ 7.5 mg/day group (n = 223) showed statistically lower median CWS [0 (IQR 0–19) vs. 48 (IQR 19–84), P < 0.001] and AIS [0 (IQR − 19–10) vs. 40 (IQR 9–74), P < 0.001] compared to the PDN > 7.5 mg/day group (n = 79). Within the low-dose group, patients with 5 < PDN ≤ 7.5 mg/day (n = 52) exhibited higher median CWS [10.5 (IQR 0–29) vs. 0 (IQR 0–19), P = 0.002] and wider AIS interquartile range [0 (IQR − 18.75–29) vs. 0 (IQR − 20–0), P = 0.010] than the PDN ≤ 5 mg/day subgroup (n = 171). No significant differences in CWS or AIS were observed between the PDN ≤ 2.5 mg/day (n = 90) and 2.5 < PDN ≤ 5 mg/day (n = 81) subgroups. Quantile regression indicated that each 1 mg/day increase in PDN dose raised median CWS by 3.33 points and median AIS by 3.42 points.

Conclusions

To our knowledge, this study provided the first prospective and quantitative evidence using the GTI to demonstrate that PDN dose reduction to ≤ 5 mg/day was linked to reduced toxicity. Moreover, we found that no dose was entirely safe, which strongly supported the EULAR strategy of rigorous GC minimization.