Impact of glucocorticoids on the incidence of lupus-related major organ damage: a systematic literature review and meta-regression analysis of longitudinal observational studies
Creators: name: Ugarte-Gil, Manuel Francisco
name: Mak, Anselm
name: Leong, Joanna
name: Dharmadhikari, Bhushan
name: Kow, Nien Yee
name: Reátegui-Sokolova, Cristina
name: Elera-Fitzcarrald, Claudia
name: Aranow, Cinthia
name: Arnaud, Laurent
name: Askanase, Anca D
name: Bae, Sang-Cheol
name: Bernatsky, Sasha
name: Bruce, Ian N
name: Buyon, Jill
name: Costedoat-Chalumeau, Nathalie
name: Dooley, Mary Ann
name: Fortin, Paul R
name: Ginzler, Ellen M
name: Gladman, Dafna D
name: Hanly, John
name: Inanc, Murat
name: Isenberg, David
name: Jacobsen, Soren
name: James, Judith A
name: Jönsen, Andreas
name: Kalunian, Kenneth
name: Kamen, Diane L
name: Lim, Sung Sam
name: Morand, Eric
name: Mosca, Marta
name: Peschken, Christine
name: Pons-Estel, Bernardo A
name: Rahman, Anisur
name: Ramsey-Goldman, Rosalind
name: Reynolds, John
name: Romero-Diaz, Juanita
name: Ruiz-Irastorza, Guillermo
name: Sánchez-Guerrero, Jorge
name: Svenungsson, Elisabet
name: Urowitz, Murray
name: Vinet, Evelyne
name: Van Vollenhoven, Ronald F
name: Voskuyl, Alexandre
name: Wallace, Daniel J
name: Petri, Michelle A
name: Manzi, Susan
name: Clarke, Ann Elaine
name: Cheung, Mike
name: Farewell, Vernon
name: Alarcon, Graciela S.
Publisher: name: Apollo - University of Cambridge Repository
Year: 2021
Subjects: Epidemiology and outcomes
1506
2257
glucocorticoids
outcome assessment
health care
lupus erythematosus
systemic

description: Funder: Lupus Foundation of America, Inc
description: 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 &lt;5 years of follow-up, &lt;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.