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 M. F., Mak A., Leong J., Dharmadhikari B., Kow N. Y., Reategui-Sokolova C., ...Daha Fazla

LUPUS SCIENCE & MEDICINE, cilt.8, sa.1, 2021 (SCI-Expanded) identifier identifier identifier

  • Yayın Türü: Makale / Derleme
  • Cilt numarası: 8 Sayı: 1
  • Basım Tarihi: 2021
  • Doi Numarası: 10.1136/lupus-2021-000590
  • Dergi Adı: LUPUS SCIENCE & MEDICINE
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Social Sciences Citation Index (SSCI), Scopus, EMBASE, MEDLINE, Directory of Open Access Journals
  • Anahtar Kelimeler: glucocorticoids, outcome assessment, health care, lupus erythematosus, systemic, ERYTHEMATOSUS PATIENTS, DISEASE DURATION, RISK-FACTORS, CARDIOVASCULAR EVENTS, LATE-ONSET, MORTALITY, EVOLUTION, OUTCOMES, WOMEN, TIME
  • İstanbul Üniversitesi Adresli: Evet

Özet

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.