POS1306 HIGHER INITIAL PREDNISONE DOSE IS NOT ASSOCIATED WITH BETTER RENAL OUTCOMES IN LUPUS NEPHRITIS PATIENTS AT 12 MONTHS: DATA FROM AN INCEPTION MULTICENTER COHORT

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Background: The current recommendations advocate initiating treatment for Lupus Nephritis (LN) with a lower prednisone dose, yet there is limited real-world evidence exploring the impact of initial corticosteroid dose on short-term renal outcomes in routine clinical practice. Objectives: To evaluate the initial glucocorticoid dose and tapering protocol, and potential differences in renal outcomes between patients treated with higher versus lower initial doses of prednisone. Methods: A cohort study of patients with histologically confirmed LN was conducted, categorizing them into those who received (based on physician discretion) an initial prednisone dose of >40 mg/day versus ≤40 mg/day [1, 2]. Patients were matched by propensity score, according to the baseline characteristics. Mean daily prednisone doses were compared at baseline, six and twelve months. In addition, multivariable regression with inverse probability of treatment weighting was performed to evaluate the association between the initial prednisone dose and the achievement of complete renal response (CRR) at 12 months. Results: A total of 160 patients were included in the study; 77% had LN class III/IV and 19.5% pure class V. Intravenous methylprednisolone pulses were administered to 72% of patients, with a median (IQR) cumulative dose of 2.0 (3.0) g. Sixty patients (38%) received an initial prednisone dose of >40 mg/day, while 100 patients (62%) received ≤40 mg/day. Significant differences were observed between the two groups regarding cumulative prednisone dose, median initial dose, and dose at 6 months (p<0.001, p<0.001, and p=0.013, respectively), but not at 12 months (p=0.735). In addition, renal response rates at 6 and 12 months did not differ between the two groups (6m: 45/55 (81.8%) vs 62/83 (74.7%), p=0.327, 12m: 35/50 (70%) vs. 50/77 (64.9%), p=0.553, for patients who had all data available at respective timepoints). After adjusting for potential confounders including age, initial administration of methylprednisolone pulses, baseline eGFR, histological LN class, and concurrent immunosuppressive therapy (cyclophosphamide vs. mycophenolate mofetil), there was no significant difference to achieve complete renal response at 12 months between the two groups (adjusted OR 0.97, 95% CI: 0.29–3.26, p>0.9) (Table 1). Conclusion: A starting prednisone dose >40 mg/day increases cumulative glucocorticoid exposure without improving renal remission rates in LN within the first year. REFERENCES: [1] Fanouriakis A, Kostopoulou M, Andersen J, Aringer M, Arnaud L, Bae SC, et al. EULAR recommendations for the management of systemic lupus erythematosus: 2023 update. Ann Rheum Dis 2023. https://doi.org/10.1136/ard-2023-224762. [2] 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) 2022;74:1451–8. https://doi.org/10.1002/acr.24592. Table 1OR95% CIp-valueAge at Ln diagnosis1.020.97- 1.070.4eGFR >600.950.23- 3.980.9NIH Activity Index0.970.87- 1.090.6NIH Chronicity Index0.530.35- 0.810.004Starting Pz dose0.29- 3.260.9• ≤40 mg/d-• >40 mg/d0.97iv S/M pulses0.780.19- 3.210.7Initial treatment0.57- 13.10.2• CYC-• MMF2.73LN class2.37- 218.00.002• Non-proliferative-• Proliferative22.7 Acknowledgements: NIL . Disclosure of Interests: None declared . © The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.

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