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 Francisco Mak, Anselm Leong, Joanna Dharmadhikari, Bhushan Kow, Nien Yee ReƔtegui-Sokolova, Cristina Elera-Fitzcarrald, Claudia Aranow, Cinthia Arnaud, Laurent Askanase, Anca D
Ugarte-Gil, Manuel Francisco
Mak, Anselm
Leong, Joanna
Dharmadhikari, Bhushan
Kow, Nien Yee
ReƔtegui-Sokolova, Cristina
Elera-Fitzcarrald, Claudia
Aranow, Cinthia
Arnaud, Laurent
Askanase, Anca D
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.
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Date
2021-12
Type
Article
Other
Other
Subject
Rheumatology
Collections
Citation
Ugarte-Gil MF, Mak A, Leong J, Dharmadhikari B, Kow NY, ReƔtegui-Sokolova C, Elera-Fitzcarrald C, Aranow C, Arnaud L, Askanase AD, Bae SC, Bernatsky S, Bruce IN, Buyon J, Costedoat-Chalumeau N, Dooley MA, Fortin PR, Ginzler EM, Gladman DD, Hanly J, Inanc M, Isenberg D, Jacobsen S, James JA, Jƶnsen A, Kalunian K, Kamen DL, Lim SS, Morand E, Mosca M, Peschken C, Pons-Estel BA, Rahman A, Ramsey-Goldman R, Reynolds J, Romero-Diaz J, Ruiz-Irastorza G, SƔnchez-Guerrero J, Svenungsson E, Urowitz M, Vinet E, van Vollenhoven RF, Voskuyl A, Wallace DJ, Petri MA, Manzi S, Clarke AE, Cheung M, Farewell V, Alarcon GS. 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 Sci Med. 2021 Dec;8(1):e000590.
Journal / Source Title
Lupus Science & Medicine
DOI
10.1136/lupus-2021-000590
PMID
34930819
Publisher
BMJ Publishing Group