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

• Published in: Lupus science & medicine Vol. 8; no. 1; p. e000590
• Main Authors: Ugarte-Gil, Manuel Francisco, Mak, Anselm, Leong, Joanna, Dharmadhikari, Bhushan, Kow, Nien Yee, Reátegui-Sokolova, Cristina, Elera-Fitzcarrald, Claudia, Aranow, Cinthia, Arnaud, Laurent, Askanase, Anca D, Bae, Sang-Cheol, Bernatsky, Sasha, Bruce, Ian N, Buyon, Jill, Costedoat-Chalumeau, Nathalie, Dooley, Mary Ann, Fortin, Paul R, Ginzler, Ellen M, Gladman, Dafna D, Hanly, John, Inanc, Murat, Isenberg, David, Jacobsen, Soren, James, Judith A, Jönsen, Andreas, Kalunian, Kenneth, Kamen, Diane L, Lim, Sung Sam, Morand, Eric, Mosca, Marta, Peschken, Christine, Pons-Estel, Bernardo A, Rahman, Anisur, Ramsey-Goldman, Rosalind, Reynolds, John, Romero-Diaz, Juanita, Ruiz-Irastorza, Guillermo, Sánchez-Guerrero, Jorge, Svenungsson, Elisabet, Urowitz, Murray, Vinet, Evelyne, van Vollenhoven, Ronald F, Voskuyl, Alexandre, Wallace, Daniel J, Petri, Michelle A, Manzi, Susan, Clarke, Ann Elaine, Cheung, Mike, Farewell, Vernon, Alarcon, Graciela S.
• Format: Journal Article
• Language: English
• Published: England Lupus Foundation of America 20.12.2021; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Angina pectoris; Clinical Medicine; Coronary vessels; Epidemiology and Outcomes; Female; glucocorticoids; Glucocorticoids - adverse effects; health care; Heart attacks; Humans; Incidence; Klinisk medicin; Literature reviews; Longitudinal Studies; Lupus; lupus erythematosus; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - drug therapy; Lupus Erythematosus, Systemic - epidemiology; Medical and Health Sciences; Medicin och hälsovetenskap; Observational studies; Observational Studies as Topic; Osteoporosis; outcome assessment; Patients; Regression Analysis; Systematic review; systemic; Teams; Variables; systemic; outcome assessment; glucocorticoids; lupus erythematosus; health care
• ISSN: 2053-8790; 2053-8790
• DOI: 10.1136/lupus-2021-000590

ObjectiveIn 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.MethodsWe 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.ResultsWe 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.ConclusionsWe 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.