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

Research output: Contribution to journalReview articlepeer-review

1 Downloads (Pure)

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 languageEnglish
Article numbere000590
Number of pages10
JournalLupus Science and Medicine
Volume8
Issue number1
DOIs
Publication statusPublished - 20 Dec 2021

Fingerprint

Dive into the research topics of 'Impact of glucocorticoids on the incidence of lupus-related major organ damage: a systematic literature review and meta-regression analysis of longitudinal observational studies'. Together they form a unique fingerprint.

Cite this