Katz Patricia, Pedro Sofia, Park Joonsuk, Choi Jiyoon, Michaud Kaleb
University of California, San Francisco.
FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas.
ACR Open Rheumatol. 2024 Dec;6(12):918-926. doi: 10.1002/acr2.11733. Epub 2024 Oct 9.
Glucocorticoids (GCs) can be beneficial from both clinical and patient perspectives, but side effects are well documented. We examined patterns of GC use over 15 years (2006-2021) and occurrence of adverse health conditions (AHCs) and health care use by GC exposure in two longitudinal cohorts with systemic lupus erythematosus (SLE).
Data from the Lupus Outcomes Study (LOS; 2003-2015) and FORWARD cohort (2015-2021) were used. AHCs examined were diabetes, osteoporosis, nontraumatic fractures, cataracts, and infections. Health care use measures examined were the number of rheumatology and other provider visits, hospitalizations, and specific diagnostic tests. Kaplan-Meier analyses examined time to occurrence of each AHC. Cox regression analyses estimated the risk of occurrence of AHCs, controlling for covariates by GC use and by GC dose (0, 1-5, 5-7.5, and ≥7.5 mg).
GC use was relatively consistent over time. At baseline, individuals who used GCs in the LOS were more likely to report osteoporosis (adjusted odds ratio [aOR] 1.7, 95% confidence interval [CI] 1.2-2.6) and cataracts (aOR 1.6, 95% CI 1.04-2.6); individuals who used GCs in the FORWARD cohort were more likely to report diabetes (aOR 5.1, 95% CI 2.2-12.0), osteoporosis (aOR 4.5, 95% CI 2.6-8.0), and fractures (aOR 6.5, 95% CI 3.8-11.1). Individuals who used high doses of GCs in the LOS had greater incidence of osteoporosis, fracture, and cataracts. In the FORWARD cohort, a significant difference in incidence was noted only for infections. In both cohorts, individuals who used GCs had more rheumatology and other physician visits, and greater risk of hospitalization.
Despite recommendations on steroid sparing, a large portion of people with SLE appear to remain on steroids. These analyses provide additional evidence of the potential health and health care burden of GC use, underscoring the need for other effective treatments for individuals with SLE.
从临床和患者角度来看，糖皮质激素（GCs）可能有益，但副作用也有充分记录。我们研究了15年（2006 - 2021年）间GCs的使用模式，以及两个系统性红斑狼疮（SLE）纵向队列中GC暴露导致的不良健康状况（AHCs）的发生情况和医疗保健使用情况。
使用了狼疮结局研究（LOS；2003 - 2015年）和前瞻性队列（2015 - 2021年）的数据。所研究的AHCs包括糖尿病、骨质疏松症、非创伤性骨折、白内障和感染。所研究的医疗保健使用指标包括风湿病科和其他科室就诊次数、住院次数以及特定诊断检查。Kaplan - Meier分析研究了每种AHC发生的时间。Cox回归分析估计了AHCs发生的风险，并通过GC使用情况和GC剂量（0、1 - 5、5 - 7.5和≥7.5毫克）对协变量进行控制。
随着时间推移，GCs的使用相对稳定。在基线时，LOS队列中使用GCs的个体更有可能报告骨质疏松症（调整优势比[aOR] 1.7，95%置信区间[CI] 1.2 - 2.6）和白内障（aOR 1.6，95% CI 1.04 - 2.6）；前瞻性队列中使用GCs的个体更有可能报告糖尿病（aOR 5.1，95% CI 2.2 - 12.0）、骨质疏松症（aOR 4.5，95% CI 2.6 - 8.0）和骨折（aOR 6.5，95% CI 3.8 - 11.1）。LOS队列中使用高剂量GCs的个体骨质疏松症、骨折和白内障的发病率更高。在前瞻性队列中，仅在感染方面观察到发病率有显著差异。在两个队列中，使用GCs的个体有更多的风湿病科和其他科室就诊次数，以及更高的住院风险。
尽管有关于减少类固醇使用的建议，但很大一部分SLE患者似乎仍在使用类固醇。这些分析提供了更多证据，证明使用GCs可能对健康和医疗保健造成负担，强调了为SLE患者提供其他有效治疗方法的必要性。
