Clinical Drug Investigation

, Volume 37, Issue 6, pp 519–524

Rate of Adverse Effects of Medium- to High-Dose Glucocorticoid Therapy in Systemic Lupus Erythematosus: A Systematic Review of Randomized Control Trials

  • Savino Sciascia
  • Elisa Mompean
  • Massimo Radin
  • Dario Roccatello
  • Maria J. Cuadrado
Systematic Review

Abstract

Background and Objectives

The efficacy of glucocorticoids (GCs) in treating systemic lupus erythematosus (SLE) is beyond doubt. However, GCs-related adverse effects (AEs) are multiple and serious. Despite the current available evidence suggesting to reduce daily doses of prednisone <7.5 mg/day, or even to withdraw it, in the real-life practice, it is not uncommon to see patients receiving medium doses (up to 30 mg/day prednisone or equivalent) or high doses (≥30 mg/day).

Methods

We systematically reviewed the literature with a priori strategy, to assess the rate of AEs related to medium or high doses of GCs in patients with SLE, analyzing randomized control trials with at least one of the treatment groups including GCs alone at medium or high doses.

Results

We found a rate of 9/100 patients/year for hyperglycemias/diabetes, 25/100 patients/year for infections, and 12/100 patients/year for avascular necrosis of the hip. Interestingly, when adjusting for GC dose and treatment duration, we observed no difference in terms of AEs comparing patients receiving medium versus high doses.

Conclusions

In the era when treat-to-target strategies have been proposed in order to control SLE disease activity, improved health-related quality of life, and reduced morbidity and mortality, using GCs in a more restrictive way should be a goal to prevent major complications in patients with SLE.

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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Savino Sciascia
    • 1
    • 2
  • Elisa Mompean
    • 3
  • Massimo Radin
    • 1
  • Dario Roccatello
    • 1
    • 2
  • Maria J. Cuadrado
    • 3
  1. 1.Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological SciencesS. Giovanni Bosco Hospital and University of TurinTurinItaly
  2. 2.SCDU Nephrology and Dialysis, Department of Clinical and Biological SciencesS. Giovanni Bosco HospitalTurinItaly
  3. 3.Louise Coote Lupus UnitGuy’s and St Thomas’ NHS Foundation TrustLondonUK

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