Lupus Science and Medicine (May 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
- Ronald F van Vollenhoven,
- Laurent Arnaud,
- Marta Mosca,
- Nathalie Costedoat-Chalumeau,
- Elisabet Svenungsson,
- Daniel J Wallace,
- Judith A James,
- Kenneth Kalunian,
- Susan Manzi,
- Michelle A Petri,
- Jill Buyon,
- Rosalind Ramsey-Goldman,
- Ian N Bruce,
- Guillermo Ruiz-Irastorza,
- Ellen M Ginzler,
- Manuel Francisco Ugarte-Gil,
- Bernardo A Pons-Estel,
- Juanita Romero-Diaz,
- Sang-Cheol Bae,
- Anisur Rahman,
- Paul R Fortin,
- Dafna D Gladman,
- Andreas Jönsen,
- Murat Inanc,
- Diane L Kamen,
- Søren Jacobsen,
- Jorge Sanchez-Guerrero,
- Évelyne Vinet,
- Murray Urowitz,
- David Isenberg,
- Sasha Bernatsky,
- John Reynolds,
- Eric Morand,
- Vernon Farewell,
- Claudia Elera-Fitzcarrald,
- Cristina Reátegui-Sokolova,
- Alexandre Voskuyl,
- Anca D Askanase,
- John Hanly,
- Anselm Mak,
- Sung Sam Lim,
- Christine Peschken,
- Graciela S. Alarcon,
- Joanna Leong,
- Bhushan Dharmadhikari,
- Nien Yee Kow,
- Cinthia Aranow,
- Mary Ann Dooley,
- Mike Cheung
Affiliations
- Ronald F van Vollenhoven
- Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Laurent Arnaud
- 1 Service de rhumatologie, Hôpitaux Universitaires de Strasbourg, Laboratoire d`Immuno Rhumatologie Moléculaire, INSERM UMR_S1109, Strasbourg, France
- Marta Mosca
- 1 Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Nathalie Costedoat-Chalumeau
- Cochin Hospital, Paris, France
- Elisabet Svenungsson
- Karolinska Institutet, Karolinska University Hospital, Rheumatology Unit, Department of Medicine, Solna, Stockholm, Sweden
- Daniel J Wallace
- Rheumatology, Cedars-Sinai Medical Center, West Hollywood, California, USA
- Judith A James
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
- Kenneth Kalunian
- 9University of California, San Diego, La Jolla, United States of America
- Susan Manzi
- Allegheny Health Network, Pittsburgh, Pennsylvania, USA
- Michelle A Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Jill Buyon
- Rheumatology, NYU Langone Health, New York City, New York, USA
- Rosalind Ramsey-Goldman
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Ian N Bruce
- Kellgren Centre for Rheumatology, Manchester University Hospitals NHS Trust, Manchester, UK
- Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
- Ellen M Ginzler
- Medicine, SUNY Downstate Medical Center, New York City, New York, USA
- Manuel Francisco Ugarte-Gil
- Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, Universidad Cientifica del Sur, Lima, Peru
- Bernardo A Pons-Estel
- 5Rheumatology, Grupo Oroño – Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
- Juanita Romero-Diaz
- Immunology and Rheumatology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Mexico
- Sang-Cheol Bae
- 28 Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea (the Republic of)
- Anisur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
- Paul R Fortin
- Division of Rheumatology, CHU de Québec, Universite Laval, Quebec City, Quebec, Canada
- Dafna D Gladman
- Krembil-Gladman Psoriatic Arthritis Research Program, Centre for Prognosis Studies in the Rheumatic Diseases, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Andreas Jönsen
- Department of Rheumatology, Lund University Department of Clinical Sciences Lund, Lund, Sweden
- Murat Inanc
- Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Fatih, Turkey
- Diane L Kamen
- Medical University of South Carolina, Charleston, South Carolina, USA
- Søren Jacobsen
- Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Jorge Sanchez-Guerrero
- Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada
- Évelyne Vinet
- McGill University, Divisions of Rheumatology and Clinical Epidemiology, Montreal, Canada
- Murray Urowitz
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- David Isenberg
- Centre for Rheumatology, Department of Medicine, University College London, London, UK
- Sasha Bernatsky
- Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
- John Reynolds
- 1 Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Eric Morand
- 1Department of Medicine, School of Clinical Sciences at MH, Monash University, Australia, Australia
- Vernon Farewell
- 1Queen Elizabeth II Health Sciences Center and Dalhousie University, Rheumatology/Medicine, Halifax, Nova Scotia, Canada
- Claudia Elera-Fitzcarrald
- Hospital Nacional Guillermo Almenara Irigoyen, Reumatologia, Lima, Peru
- Cristina Reátegui-Sokolova
- Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen, EsSaalud, Lima, Peru
- Alexandre Voskuyl
- VUmc, Rheumatology, Amsterdam, Netherlands
- Anca D Askanase
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- John Hanly
- 1Queen Elizabeth II Health Sciences Center and Dalhousie University, Rheumatology/Medicine, Halifax, Nova Scotia, Canada
- Anselm Mak
- Division of Rheumatology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Sung Sam Lim
- 3Department of Medicine, Division of Rheumatology, Emory University School of Medicine, USA
- Christine Peschken
- University of Manitoba, Winnipeg, Manitoba, Canada
- Graciela S. Alarcon
- The University of Alabama, Birmingham, USA, School of Medicine, Birmingham, United States of America
- Joanna Leong
- Department of Medicine, Changi General Hospital, Singapore
- Bhushan Dharmadhikari
- Department of Physiology, National University of Singapore, Singapore, Singapore
- Nien Yee Kow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Cinthia Aranow
- Feinstein Institute for Medical Research, Manhasset, New York, USA
- Mary Ann Dooley
- Thurston Arthritis Research Centre, University of North Carolina System, Chapel Hill, North Carolina, USA
- Mike Cheung
- Department of Psychology, Faculty of Arts and Social Sciences, National University of Singapore, Singapore
- DOI
- https://doi.org/10.1136/lupus-2021-000590
- Journal volume & issue
-
Vol. 8,
no. 1
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.
