Impact of glucocorticoids on the incidence of lupus-related major organ damage:  a systematic literature review and meta-regression analysis of longitudinal observational studies

Manuel Ugarte-Gil; Anselm Mak; Joanna  Leong; Bushan Dharmadhikari; Nien Yee Kow; Cristina  Reategui-Sokolova; Claudia Elera-Fitzcarrald; Cynthia Aranow; Laurent Arnaud; Anca Askanase; Sang-Cheol  Bae; Sasha Bernatsky; Ian Bruce; Jill Buyon; Nathalie Costedoat-Chalumeau; Mary Anne Dooley; Paul Fortin; Ellen Ginzler; Dafna Gladman; John Hanly; Murat Inanc; David Isenberg; Soren Jacobsen; Judith James; Andreas Jonsen; Ken Kalunian; Diane Kamen; Sam Lim; Eric  Morand; Marta Mosca; Christine Peshken; Bernado Pons-Estel; Anisur Rahman; Rosalind Ramsey-Goldman; John Reynolds; Juanita Romero-Diaz; Guillermo Ruiz-Irastorza; Jorge Sanchez-Guerro; Elisabet Svenungsson; Murray Urowitz; Evelyne Vinet; Ronald van Vollenhoven; Alexandre Voskuyl; Daniel Wallace; Michelle Petri; Susan Manzi; Ann Clarke; Mike W-L Chueng; Vernon Farewell; Graciela Alarcon

doi:10.1136/lupus-2021-000590

Impact of glucocorticoids on the incidence of lupus-related major organ damage: a systematic literature review and meta-regression analysis of longitudinal observational studies

Manuel Ugarte-Gil, Anselm Mak, Joanna Leong, Bushan Dharmadhikari, Nien Yee Kow, Cristina Reategui-Sokolova, Claudia Elera-Fitzcarrald, Cynthia Aranow, Laurent Arnaud, Anca Askanase, Sang-Cheol Bae, Sasha Bernatsky, Ian Bruce, Jill Buyon, Nathalie Costedoat-Chalumeau, Mary Anne Dooley, Paul Fortin, Ellen Ginzler, Dafna Gladman, John HanlyMurat Inanc, David Isenberg, Soren Jacobsen, Judith James, Andreas Jonsen, Ken Kalunian, Diane Kamen, Sam Lim, Eric Morand, Marta Mosca, Christine Peshken, Bernado Pons-Estel, Anisur Rahman, Rosalind Ramsey-Goldman, John Reynolds, Juanita Romero-Diaz, Guillermo Ruiz-Irastorza, Jorge Sanchez-Guerro, Elisabet Svenungsson, Murray Urowitz, Evelyne Vinet, Ronald van Vollenhoven, Alexandre Voskuyl, Daniel Wallace, Michelle Petri, Susan Manzi, Ann Clarke, Mike W-L Chueng, Vernon Farewell, Graciela Alarcon

Inflammation and Ageing

Research output: Contribution to journal › Review article › peer-review

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Abstract

Objective: In systemic lupus erythematosus (SLE), disease activity and glucocorticoid (GC) exposure are known to contribute to irreversible organ damage. We aimed to examine the association between GC exposure and organ damage occurrence.

Methods: We conducted a literature search (PubMed (Medline), Embase and Cochrane January 1966–October 2021). We identified original longitudinal observational studies reporting GC exposure as the proportion of users and/or GC use with dose information as well as the occurrence of new major organ damage as defined in the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index. Meta-regression analyses were performed. Reviews, case-reports and studies with <5 years of follow-up, <50 patients, different outcomes and special populations were excluded.

Results: We selected 49 articles including 16 224 patients, 14 755 (90.9%) female with a mean age and disease duration of 35.1 years and of 37.1 months. The mean follow-up time was 104.9 months. For individual damage items, the average daily GC dose was associated with the occurrence of overall cardiovascular events and with osteoporosis with fractures. A higher average cumulative dose adjusted (or not)/number of follow-up years and a higher proportion of patients on GC were associated with the occurrence of osteonecrosis.

Conclusions: We confirm associations of GC use with three specific damage items. In treating patients with SLE, our aim should be to maximise the efficacy of GC and to minimise their harms.

Original language	English
Article number	e000590
Number of pages	10
Journal	Lupus Science and Medicine
Volume	8
Issue number	1
DOIs	https://doi.org/10.1136/lupus-2021-000590
Publication status	Published - 20 Dec 2021

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Ugarte-Gil, M., Mak, A., Leong, J., Dharmadhikari, B., Kow, N. Y., Reategui-Sokolova, C., Elera-Fitzcarrald, C., Aranow, C., Arnaud, L., Askanase, A., Bae, S.-C., Bernatsky, S., Bruce, I., Buyon, J., Costedoat-Chalumeau, N., Dooley, M. A., Fortin, P., Ginzler, E., Gladman, D., ... Alarcon, G. (2021). Impact of glucocorticoids on the incidence of lupus-related major organ damage: a systematic literature review and meta-regression analysis of longitudinal observational studies. Lupus Science and Medicine, 8(1), Article e000590. https://doi.org/10.1136/lupus-2021-000590

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title = "Impact of glucocorticoids on the incidence of lupus-related major organ damage: a systematic literature review and meta-regression analysis of longitudinal observational studies",

abstract = "Objective: In systemic lupus erythematosus (SLE), disease activity and glucocorticoid (GC) exposure are known to contribute to irreversible organ damage. We aimed to examine the association between GC exposure and organ damage occurrence.Methods: We conducted a literature search (PubMed (Medline), Embase and Cochrane January 1966–October 2021). We identified original longitudinal observational studies reporting GC exposure as the proportion of users and/or GC use with dose information as well as the occurrence of new major organ damage as defined in the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index. Meta-regression analyses were performed. Reviews, case-reports and studies with <5 years of follow-up, <50 patients, different outcomes and special populations were excluded.Results: We selected 49 articles including 16 224 patients, 14 755 (90.9%) female with a mean age and disease duration of 35.1 years and of 37.1 months. The mean follow-up time was 104.9 months. For individual damage items, the average daily GC dose was associated with the occurrence of overall cardiovascular events and with osteoporosis with fractures. A higher average cumulative dose adjusted (or not)/number of follow-up years and a higher proportion of patients on GC were associated with the occurrence of osteonecrosis.Conclusions: We confirm associations of GC use with three specific damage items. In treating patients with SLE, our aim should be to maximise the efficacy of GC and to minimise their harms.",

author = "Manuel Ugarte-Gil and Anselm Mak and Joanna Leong and Bushan Dharmadhikari and Kow, {Nien Yee} and Cristina Reategui-Sokolova and Claudia Elera-Fitzcarrald and Cynthia Aranow and Laurent Arnaud and Anca Askanase and Sang-Cheol Bae and Sasha Bernatsky and Ian Bruce and Jill Buyon and Nathalie Costedoat-Chalumeau and Dooley, {Mary Anne} and Paul Fortin and Ellen Ginzler and Dafna Gladman and John Hanly and Murat Inanc and David Isenberg and Soren Jacobsen and Judith James and Andreas Jonsen and Ken Kalunian and Diane Kamen and Sam Lim and Eric Morand and Marta Mosca and Christine Peshken and Bernado Pons-Estel and Anisur Rahman and Rosalind Ramsey-Goldman and John Reynolds and Juanita Romero-Diaz and Guillermo Ruiz-Irastorza and Jorge Sanchez-Guerro and Elisabet Svenungsson and Murray Urowitz and Evelyne Vinet and {van Vollenhoven}, Ronald and Alexandre Voskuyl and Daniel Wallace and Michelle Petri and Susan Manzi and Ann Clarke and Chueng, {Mike W-L} and Vernon Farewell and Graciela Alarcon",

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month = dec,

day = "20",

doi = "10.1136/lupus-2021-000590",

language = "English",

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journal = "Lupus Science and Medicine",

issn = "2053-8790",

publisher = "BMJ Publishing Group",

number = "1",

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Ugarte-Gil, M, Mak, A, Leong, J, Dharmadhikari, B, Kow, NY, Reategui-Sokolova, C, Elera-Fitzcarrald, C, Aranow, C, Arnaud, L, Askanase, A, Bae, S-C, Bernatsky, S, Bruce, I, Buyon, J, Costedoat-Chalumeau, N, Dooley, MA, Fortin, P, Ginzler, E, Gladman, D, Hanly, J, Inanc, M, Isenberg, D, Jacobsen, S, James, J, Jonsen, A, Kalunian, K, Kamen, D, Lim, S, Morand, E, Mosca, M, Peshken, C, Pons-Estel, B, Rahman, A, Ramsey-Goldman, R, Reynolds, J, Romero-Diaz, J, Ruiz-Irastorza, G, Sanchez-Guerro, J, Svenungsson, E, Urowitz, M, Vinet, E, van Vollenhoven, R, Voskuyl, A, Wallace, D, Petri, M, Manzi, S, Clarke, A, Chueng, MW-L, Farewell, V & Alarcon, G 2021, 'Impact of glucocorticoids on the incidence of lupus-related major organ damage: a systematic literature review and meta-regression analysis of longitudinal observational studies', Lupus Science and Medicine, vol. 8, no. 1, e000590. https://doi.org/10.1136/lupus-2021-000590

Impact of glucocorticoids on the incidence of lupus-related major organ damage: a systematic literature review and meta-regression analysis of longitudinal observational studies. / Ugarte-Gil, Manuel; Mak, Anselm; Leong, Joanna et al.
In: Lupus Science and Medicine, Vol. 8, No. 1, e000590, 20.12.2021.

Research output: Contribution to journal › Review article › peer-review

TY - JOUR

T1 - Impact of glucocorticoids on the incidence of lupus-related major organ damage

T2 - a systematic literature review and meta-regression analysis of longitudinal observational studies

AU - Ugarte-Gil, Manuel

AU - Mak, Anselm

AU - Leong, Joanna

AU - Dharmadhikari, Bushan

AU - Kow, Nien Yee

AU - Reategui-Sokolova, Cristina

AU - Elera-Fitzcarrald, Claudia

AU - Aranow, Cynthia

AU - Arnaud, Laurent

AU - Askanase, Anca

AU - Bae, Sang-Cheol

AU - Bernatsky, Sasha

AU - Bruce, Ian

AU - Buyon, Jill

AU - Costedoat-Chalumeau, Nathalie

AU - Dooley, Mary Anne

AU - Fortin, Paul

AU - Ginzler, Ellen

AU - Gladman, Dafna

AU - Hanly, John

AU - Inanc, Murat

AU - Isenberg, David

AU - Jacobsen, Soren

AU - James, Judith

AU - Jonsen, Andreas

AU - Kalunian, Ken

AU - Kamen, Diane

AU - Lim, Sam

AU - Morand, Eric

AU - Mosca, Marta

AU - Peshken, Christine

AU - Pons-Estel, Bernado

AU - Rahman, Anisur

AU - Ramsey-Goldman, Rosalind

AU - Reynolds, John

AU - Romero-Diaz, Juanita

AU - Ruiz-Irastorza, Guillermo

AU - Sanchez-Guerro, Jorge

AU - Svenungsson, Elisabet

AU - Urowitz, Murray

AU - Vinet, Evelyne

AU - van Vollenhoven, Ronald

AU - Voskuyl, Alexandre

AU - Wallace, Daniel

AU - Petri, Michelle

AU - Manzi, Susan

AU - Clarke, Ann

AU - Chueng, Mike W-L

AU - Farewell, Vernon

AU - Alarcon, Graciela

PY - 2021/12/20

Y1 - 2021/12/20

N2 - Objective: In systemic lupus erythematosus (SLE), disease activity and glucocorticoid (GC) exposure are known to contribute to irreversible organ damage. We aimed to examine the association between GC exposure and organ damage occurrence.Methods: We conducted a literature search (PubMed (Medline), Embase and Cochrane January 1966–October 2021). We identified original longitudinal observational studies reporting GC exposure as the proportion of users and/or GC use with dose information as well as the occurrence of new major organ damage as defined in the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index. Meta-regression analyses were performed. Reviews, case-reports and studies with <5 years of follow-up, <50 patients, different outcomes and special populations were excluded.Results: We selected 49 articles including 16 224 patients, 14 755 (90.9%) female with a mean age and disease duration of 35.1 years and of 37.1 months. The mean follow-up time was 104.9 months. For individual damage items, the average daily GC dose was associated with the occurrence of overall cardiovascular events and with osteoporosis with fractures. A higher average cumulative dose adjusted (or not)/number of follow-up years and a higher proportion of patients on GC were associated with the occurrence of osteonecrosis.Conclusions: We confirm associations of GC use with three specific damage items. In treating patients with SLE, our aim should be to maximise the efficacy of GC and to minimise their harms.

AB - Objective: In systemic lupus erythematosus (SLE), disease activity and glucocorticoid (GC) exposure are known to contribute to irreversible organ damage. We aimed to examine the association between GC exposure and organ damage occurrence.Methods: We conducted a literature search (PubMed (Medline), Embase and Cochrane January 1966–October 2021). We identified original longitudinal observational studies reporting GC exposure as the proportion of users and/or GC use with dose information as well as the occurrence of new major organ damage as defined in the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index. Meta-regression analyses were performed. Reviews, case-reports and studies with <5 years of follow-up, <50 patients, different outcomes and special populations were excluded.Results: We selected 49 articles including 16 224 patients, 14 755 (90.9%) female with a mean age and disease duration of 35.1 years and of 37.1 months. The mean follow-up time was 104.9 months. For individual damage items, the average daily GC dose was associated with the occurrence of overall cardiovascular events and with osteoporosis with fractures. A higher average cumulative dose adjusted (or not)/number of follow-up years and a higher proportion of patients on GC were associated with the occurrence of osteonecrosis.Conclusions: We confirm associations of GC use with three specific damage items. In treating patients with SLE, our aim should be to maximise the efficacy of GC and to minimise their harms.

U2 - 10.1136/lupus-2021-000590

DO - 10.1136/lupus-2021-000590

M3 - Review article

SN - 2053-8790

VL - 8

JO - Lupus Science and Medicine

JF - Lupus Science and Medicine

IS - 1

M1 - e000590

ER -

Impact of glucocorticoids on the incidence of lupus-related major organ damage: a systematic literature review and meta-regression analysis of longitudinal observational studies

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