Comparison of high versus low–medium prednisone doses for the treatment of systemic lupus erythematosus patients with high activity at diagnosis

International and multidisciplinary expert recommendations for the use of biologics in systemic lupus erythematosus

“…-During rating rounds by the EG, a proposal was considered: o Appropriate / non-appropriate (strong agreement):  if the median response was ≥7 AND the response distribution was [7][8][9], the recommendation may be accepted as such, without the need for a second round of scoring;  if the median was ≤3 AND response distribution was [1][2][3], the recommendation was rejected as such. o Relative agreement / uncertain (indecision / no consensus):…”

“… if the median was ≥7 AND the response distribution was [5][6][7][8][9] OR if the median was ≤3.5 AND the response distribution was [1][2][3][4][5], the result was relative agreement;  if the median was 4-6.5 AND the response distribution was [1][2][3][4][5][6][7][8][9], the result was indecision;  in all other situations (with at least one extreme value in score distribution), the result was no consensus. In the 3 last cases, the SG had to discuss the recommendation before a second round of scoring.…”

“…-During the reading step, o if ≥ 90% of the RG response distribution was [5][6][7][8][9] (i.e., the RG confirmed the appropriateness), the recommendation was maintained, and relevant comments were considered to improve the wording; o if < 90% of the RG response distribution was [5][6][7][8][9] (i.e., the RG is undecided or disagrees), the SG offered possible changes based on RG comments, after debate or voting with the EG in case of substantial changes, or rejected the recommendation. M A N U S C R I P T…”

“…Patients with SLE are followed by different specialists because of several organ involvements, and treatments are tailored depending on the disease activity and/or severity of the organ involvement(s), comorbidities, side effects, drug interactions, drug availability, previous treatment and patient preference. Poorly controlled disease drives a vicious circle, with organ damage undermining the longterm prognosis (1)(2)(3), triggered itself by persistent disease activity and particularly by corticosteroids abuse (4)(5)(6)(7)(8)(9)(10). Hence, the main target in clinical practice is to prevent damage and maintain stable disease control with limited doses of corticosteroids (7,11) An evidence-based approach to therapy is desirable, but the actual benefit demonstrated by randomized controlled trials and cohort evaluations of biologics in SLE are still limited (10,12).…”

Evidence-based treatment of systemic lupus erythematosus and its complications

“…A recent study demonstrated that moderate doses (≤30 mg/day) of CS for severe nonrenal SLE were as effective and associated with fewer adverse effects than high doses. [5] Another study demonstrated that after pulse methylprednisolone, oral CS may be omitted from an induction immunosuppressive regimen for nephritis. [6] An understanding of currently available immunosuppressant drugs such as methotrexate (MTX), azathioprine (AZA), cyclophosphamide (CYC) and mycophenylate mofetil (MMF) is vital in a steroidsparing approach (Table 2).…”