Glucocorticoid treatment in SLE is associated with infections, comorbidities and mortality—a national cohort study

Abstract

Objectives Patients with SLE have an increased risk of comorbidities and impaired survival. We aimed to assess if various thresholds of oral corticosteroids (OCS) can predict development of infections, comorbidities, malignancies and survival in SLE using data from national health registries in Sweden. Methods All incident SLE cases, age >18 years, in Sweden (n = 5309) between 2005 and 2020 and matched population controls (n = 26545) were included and followed until 2020, total 257 942 patient years. Data from national registers were retrieved including information from the National Prescribed Drug Register. Risk factors were analysed using time-dependent Cox regression models. Results Compared with no OCS, >0 to < 5.0 mg/day, 5.0–7.5 mg/day as well as > 7.5 mg OCS/day predicted development of infections (pneumonia, influenza, herpes zoster and urinary tract infection), osteoporosis, osteonecrosis, gastroduodenal ulcers, cataracts, hypertension and mortality (all p< 0.05). OCS >0 to < 5.0 mg/day was associated with lower hazard ratios for these comorbidities than higher doses of OCS. Fifteen years after diagnosis, 48% of patients were taking OCS at a median dose of 5.7 mg/day. A small reduction of OCS treatment 5 years after diagnosis in patients diagnosed with SLE 2006–2010 compared with 2011–2015 was observed, 49% vs. 46% respectively (p= 0.039). Conclusion Results highlight the potential harm associated with even low OCS dose treatment in SLE and the need to judiciously use OCS at the lowest possible dose to maximize efficacy and minimize harm.

Anifrolumab treatment improves patient-reported quality of life and decreases disease activity and corticosteroid use in patients with systemic lupus erythematosus: A qualitative study in Denmark

“…This is because even low doses of systemic glucocorticoid treatment are associated with an increased risk of infections, osteoporosis, and increased mortality. 25 In the current study, we observed a reduction in steroid use across patients, fulfilling one of the purposes of adding Anifrolumab to the standard of care in SLE treatment. Further, in 44% of cases, we could avoid reintroducing steroids during the patient's flare by adding Anifrolumab to standard of care.…”

Environment and systemic lupus erythematosus

“…SLE patients, in fact, are a population at increased infection risk due to both the aberrant immune system and glucocorticoids and other immunosuppressants used to treat the disease. Although prognosis has considerably improved over the years, infections still remain a major cause of hospitalisation and mortality in patients with SLE, especially in the early phase of disease (56)(57)(58). Although controversial, the crucial interplay between SLE and infections must draw attention to the importance of preventive measures such as vaccination.…”

The prevalence of neutropenia and association with infections in patients with systemic lupus erythematosus: a Swedish single-center study conducted over 14 years

“…Thus, SLE continues to represent a major challenge for both patients and physicians. Inappropriate or incomplete management of SLE disease activity and/or the side effects of administered therapies, particularly corticosteroids, may lead to comorbidities, irreversible organ damage, decreased health-related quality of life, and increased mortality [2][3][4].…”