Restrictive Use of Oral Glucocorticoids in Systemic Lupus Erythematosus and Prevention of Damage Without Worsening Long‐Term Disease Control: An Observational Study

Objective To analyze the influence of 2 different treatment strategies on general and specific damage accrual in patients with systemic lupus erythematosus (SLE). Methods Two cohorts were identified according to the responsible physicians: patients treated at the autoimmune diseases unit (ADU), and patients treated by other members of the internal medicine (IM) department. Members of the ADU worked with a protocol including the universal prescription of hydroxychloroquine (HCQ), the use of maximum oral prednisone dosages ≤30 mg/day and maintenance therapy with ≤5 mg/day, by using methylprednisolone pulses and/or early immunosuppressive (IS) drugs. We analyzed the influence of these 2 treatment strategies on damage accrual, both general and domain specific, attributed to glucocorticoids, cardiovascular (CV) disease, SLE, and unclassified, since the diagnosis of disease in patients with a followup ≥5 years. Results A total of 74 patients were included in the ADU group and 213 in the IM group. They were comparable for most demographic and lupus‐related variables. ADU patients received prednisone later and at lower doses, more methylprednisolone pulses, earlier IS drugs and more HCQ (P < 0.05 for all comparisons). The Systemic Lupus Erythematosus Disease Activity Index score decreased similarly in both cohorts (P = 0.4). Patients in the ADU group were less likely to accrue any damage (P = 0.007). They accrued less glucocorticoid‐related (adjusted hazard ratio [HR] 0.23 [95% confidence interval (95% CI) 0.07–0.80]), CV disease (adjusted HR 0.28 [95% CI 0.08–0.95]), and unclassified damage (adjusted HR 0.58 [95% CI 0.3–1.1]). Both groups accrued similar SLE‐related damage (adjusted HR 0.84 [95% CI 0.40–1.75]). Conclusion The use of reduced oral prednisone doses, which was possible by combining different therapies, reduced glucocorticoid‐related damage and improved CV prognosis without increasing damage caused by SLE. Video Video