A recent Mayo Clinic study highlights the link between glucocorticoid dosage and outcomes in patients with lupus nephritis, a type of kidney inflammation caused by lupus. Glucocorticoids are potent anti-inflammatory medications often used to help treat this condition.

Researchers discovered that while higher doses of these steroids can improve kidney function, they also may increase the risk of serious infections and death, further warranting the need for individualized treatment for patients suffering from this autoimmune disorder. 

The study analyzed data from multiple clinical trials involving 3,231 patients with lupus nephritis.

"We used a statistical method that analyzes data from multiple studies to uncover relationships between variables that help clinicians apply new knowledge to patient care," says M. Hassan Murad, M.D., co-author and medical director of the Knowledge Synthesis Program in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.  

Researchers found that starting treatment with a higher dose of steroids, like 60 milligrams of prednisone per day, increased the chances of improvement in kidney function after treatment compared to lower doses.

"Patients with lupus need to be educated about steroids and their risks and benefits," says senior author Alí Duarte García, M.D., a rheumatologist and director of Mayo's Lupus Clinic.  "Currently, these are necessary drugs for treatment," he adds. "At higher doses, you have a higher complete renal response, a good outcome, but also a higher risk of infections and death."  

The research also revealed that pulse dosing — giving an additional higher dose of medication administered over a short period — helps improve the likelihood of kidneys returning to normal functioning after treatment and has little effect on infections and death when combined with lower doses of oral steroids.

"Steroids have been used for 75 years, but there was minimal evidence about dosing," says Dr. Duarte García. "This research provides information to help inform medical decision-making and ultimately improve patient outcomes."

Looking ahead, the researchers suggest focusing on generating evidence preferentially based on clinical pragmatic trials that test medical interventions in everyday clinical settings and real-world circumstances, comparing different glucocorticoid regimens.

"Thanks to the Kern Health Care Delivery Scholars Program," says Dr. Duarte García, "I was able to conduct this research with resources and mentorship that have enabled me to guide and mentor the next generation of clinician-scientists, several of whom are co-authors on this study."

About Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery

The Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery collaborates with clinical areas across Mayo to create and evaluate data-driven solutions to transform the experience of health and healthcare for patients, staff and communities. It drives continuous improvement of Mayo Clinic as a learning health system, enabling safe, evidence-based, high-quality care.

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