Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

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

Frodlund, Martina ; Jönsen, Andreas LU ; Remkus, Lauren ; Telg, Gunilla ; Söderdahl, Fabian and Leonard, Dag (2024) In Rheumatology (United Kingdom) 63(4). p.1104-1112
Abstract

Objectives: Patients with SLE have an increased risk of comorbidities and impaired survival. We aimed to assess whether various thresholds of oral CS (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 ¼ 5309) between 2005 and 2020 and matched population controls (n ¼ 26 545) were included and followed until 2020, a total of 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,... (More)

Objectives: Patients with SLE have an increased risk of comorbidities and impaired survival. We aimed to assess whether various thresholds of oral CS (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 ¼ 5309) between 2005 and 2020 and matched population controls (n ¼ 26 545) were included and followed until 2020, a total of 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/day OCS 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 2006–10 compared with 2011–15 was observed, 49% vs 46% respectively (P ¼ 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.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
comorbidities, corticosteroids, immunosuppressants, infections, malignancies, mortality, organ damage, prednisolone, SLE, survival
in
Rheumatology (United Kingdom)
volume
63
issue
4
pages
9 pages
publisher
Oxford University Press
external identifiers
  • pmid:37439705
  • scopus:85189553141
ISSN
1462-0324
DOI
10.1093/rheumatology/kead348
language
English
LU publication?
yes
id
9898bdbe-45aa-4042-92ae-5846b3a41ef5
date added to LUP
2024-04-25 12:44:06
date last changed
2024-09-27 03:05:48
@article{9898bdbe-45aa-4042-92ae-5846b3a41ef5,
  abstract     = {{<p>Objectives: Patients with SLE have an increased risk of comorbidities and impaired survival. We aimed to assess whether various thresholds of oral CS (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 &gt;18 years, in Sweden (n ¼ 5309) between 2005 and 2020 and matched population controls (n ¼ 26 545) were included and followed until 2020, a total of 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, &gt;0 to &lt;5.0 mg/day, 5.0–7.5 mg/day as well as &gt;7.5 mg/day OCS predicted development of infections (pneumonia, influenza, herpes zoster and urinary tract infection), osteoporosis, osteonecrosis, gastroduodenal ulcers, cataracts, hypertension and mortality (all P &lt; 0.05). OCS &gt;0 to &lt;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 2006–10 compared with 2011–15 was observed, 49% vs 46% respectively (P ¼ 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.</p>}},
  author       = {{Frodlund, Martina and Jönsen, Andreas and Remkus, Lauren and Telg, Gunilla and Söderdahl, Fabian and Leonard, Dag}},
  issn         = {{1462-0324}},
  keywords     = {{comorbidities; corticosteroids; immunosuppressants; infections; malignancies; mortality; organ damage; prednisolone; SLE; survival}},
  language     = {{eng}},
  month        = {{04}},
  number       = {{4}},
  pages        = {{1104--1112}},
  publisher    = {{Oxford University Press}},
  series       = {{Rheumatology (United Kingdom)}},
  title        = {{Glucocorticoid treatment in SLE is associated with infections, comorbidities and mortality—a national cohort study}},
  url          = {{http://dx.doi.org/10.1093/rheumatology/kead348}},
  doi          = {{10.1093/rheumatology/kead348}},
  volume       = {{63}},
  year         = {{2024}},
}