PT  - JOURNAL ARTICLE
AU  - Manuel Francisco Ugarte-Gil
AU  - Anselm Mak
AU  - Joanna Leong
AU  - Bhushan Dharmadhikari
AU  - Nien Yee Kow
AU  - Cristina Reátegui-Sokolova
AU  - Claudia Elera-Fitzcarrald
AU  - Cinthia Aranow
AU  - Laurent Arnaud
AU  - Anca D Askanase
AU  - Sang-Cheol Bae
AU  - Sasha Bernatsky
AU  - Ian N Bruce
AU  - Jill Buyon
AU  - Nathalie Costedoat-Chalumeau
AU  - Mary Ann Dooley
AU  - Paul R Fortin
AU  - Ellen M Ginzler
AU  - Dafna D Gladman
AU  - John Hanly
AU  - Murat Inanc
AU  - David Isenberg
AU  - Soren Jacobsen
AU  - Judith A James
AU  - Andreas Jönsen
AU  - Kenneth Kalunian
AU  - Diane L Kamen
AU  - Sung Sam Lim
AU  - Eric Morand
AU  - Marta Mosca
AU  - Christine Peschken
AU  - Bernardo A Pons-Estel
AU  - Anisur Rahman
AU  - Rosalind Ramsey-Goldman
AU  - John Reynolds
AU  - Juanita Romero-Diaz
AU  - Guillermo Ruiz-Irastorza
AU  - Jorge Sánchez-Guerrero
AU  - Elisabet Svenungsson
AU  - Murray Urowitz
AU  - Evelyne Vinet
AU  - Ronald F van Vollenhoven
AU  - Alexandre Voskuyl
AU  - Daniel J Wallace
AU  - Michelle A Petri
AU  - Susan Manzi
AU  - Ann Elaine Clarke
AU  - Mike Cheung
AU  - Vernon Farewell
AU  - Graciela S. Alarcon
TI  - Impact of glucocorticoids on the incidence of lupus-related major organ damage: a systematic literature review and meta-regression analysis of longitudinal observational studies
AID  - 10.1136/lupus-2021-000590
DP  - 2021 Dec 01
TA  - Lupus Science & Medicine
PG  - e000590
VI  - 8
IP  - 1
4099  - http://lupus.bmj.com/content/8/1/e000590.short
4100  - http://lupus.bmj.com/content/8/1/e000590.full
SO  - Lupus Sci Med2021 Dec 01; 8
AB  - 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.All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.