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

Manuel Francisco Ugarte-Gil, Anselm Mak, Joanna Leong, Bhushan Dharmadhikari, Nien Yee Kow, Cristina Reátegui-Sokolova, Claudia Elera-Fitzcarrald, Cinthia Aranow, Laurent Arnaud, Anca D. Askanase, Sang Cheol Bae, Sasha Bernatsky, Ian N. Bruce, Jill Buyon, Nathalie Costedoat-Chalumeau, Mary Ann Dooley, Paul R. Fortin, Ellen M. Ginzler, Dafna D. Gladman, John HanlyMurat Inanc, David Isenberg, Soren Jacobsen, Judith A. James, Andreas Jönsen, Kenneth Kalunian, Diane L. Kamen, Sung Sam Lim, Eric Morand, Marta Mosca, Christine Peschken, Bernardo A. Pons-Estel, Anisur Rahman, Rosalind Ramsey-Goldman, John Reynolds, Juanita Romero-Diaz, Guillermo Ruiz-Irastorza, Jorge Sánchez-Guerrero, Elisabet Svenungsson, Murray Urowitz, Evelyne Vinet, Ronald F. Van Vollenhoven, Alexandre Voskuyl, Daniel J. Wallace, Michelle A. Petri, Susan Manzi, Ann Elaine Clarke, Mike Cheung, Vernon Farewell, Graciela S. Alarcon

Research output: Contribution to journalReview ArticleResearchpeer-review

33 Citations (Scopus)


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.

Original languageEnglish
Article numbere000590
Number of pages10
JournalLupus Science and Medicine
Issue number1
Publication statusPublished - 20 Dec 2021


  • glucocorticoids
  • health care
  • lupus erythematosus
  • outcome assessment
  • systemic

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