It hasn't gone away

the problem of glucocorticoid use in lupus remains

Diane Apostolopoulos, Eric F. Morand

Research output: Contribution to journalReview ArticleResearchpeer-review

17 Citations (Scopus)

Abstract

The treatment of SLE remains complex, and management is constrained by a lack of safe, effective, targeted therapies. Physicians, also, are constrained by a lack of evidence-based approaches with existing agents, including glucocorticoids, utilized in the majority of patients. While Cushingoid side effects of glucocorticoids are widely recognized, emerging literature now suggests that glucocorticoid use actually contributes to harmful outcomes in SLE, over and above these effects. These studies provide a compelling case for a re-evaluation of the long-term use of glucocorticoids in SLE, focusing on minimizing glucocorticoid exposure as part of the strategy to improve long-term outcomes. In this article, we review the evidence for the harmful effects of glucocorticoids in SLE, and propose therapeutic options that reduce reliance on glucocorticoids. We propose that it is time for the lupus community to have a louder conversation about glucocorticoid use, and for any residual complacency about their risk-benefit ratio to be banished.

Original languageEnglish
Pages (from-to)i114-i122
Number of pages9
JournalRheumatology
Volume56
Issue number1
DOIs
Publication statusPublished - 1 Apr 2017

Keywords

  • corticosteroids
  • damage
  • glucocorticoids
  • lupus
  • outcomes
  • prednisolone
  • prednisone
  • SLE
  • steroids
  • systemic lupus erythematosus

Cite this

Apostolopoulos, Diane ; Morand, Eric F. / It hasn't gone away : the problem of glucocorticoid use in lupus remains. In: Rheumatology. 2017 ; Vol. 56, No. 1. pp. i114-i122.
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It hasn't gone away : the problem of glucocorticoid use in lupus remains. / Apostolopoulos, Diane; Morand, Eric F.

In: Rheumatology, Vol. 56, No. 1, 01.04.2017, p. i114-i122.

Research output: Contribution to journalReview ArticleResearchpeer-review

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AB - The treatment of SLE remains complex, and management is constrained by a lack of safe, effective, targeted therapies. Physicians, also, are constrained by a lack of evidence-based approaches with existing agents, including glucocorticoids, utilized in the majority of patients. While Cushingoid side effects of glucocorticoids are widely recognized, emerging literature now suggests that glucocorticoid use actually contributes to harmful outcomes in SLE, over and above these effects. These studies provide a compelling case for a re-evaluation of the long-term use of glucocorticoids in SLE, focusing on minimizing glucocorticoid exposure as part of the strategy to improve long-term outcomes. In this article, we review the evidence for the harmful effects of glucocorticoids in SLE, and propose therapeutic options that reduce reliance on glucocorticoids. We propose that it is time for the lupus community to have a louder conversation about glucocorticoid use, and for any residual complacency about their risk-benefit ratio to be banished.

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