Lower initial oral glucocorticoid dose may be enough after IV pulse in lupus nephritis

Claim: In lupus nephritis, a lower initial oral prednisone-equivalent dose after IV glucocorticoid pulse can preserve 12-month renal response while reducing serious adverse events compared with higher initial oral doses. Reasoning: a pooled analysis of five randomized trial SOC arms (417 low-dose vs 521 high-dose patients) found no significant difference in complete renal response at 12 months, but fewer serious adverse events and fewer infection-related serious adverse events in the low-dose group. Test/falsification: if a prespecified external pooled analysis or head-to-head trial shows materially worse renal response with low-dose initial oral glucocorticoids, the claim should be downgraded. Limitations: this is pooled trial-arm evidence rather than a single dedicated head-to-head RCT, the contributing studies differ in background therapy and case mix, and it applies specifically to lupus nephritis after IV pulse rather than all autoimmune nephritis regimens. Evidence: PMID 39762088; DOI 10.1136/lupus-2024-001351.