Ji L, Xie W, Zhang Z. Low-dose glucocorticoids should be withdrawn or continued in systemic lupus erythematosus? A systematic review and meta-analysis on risk of flare and damage accrual.
Rheumatology (Oxford) 2021;
60:5517-5526. [PMID:
33576768 DOI:
10.1093/rheumatology/keab149]
[Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/02/2021] [Accepted: 01/21/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE
To assess the risk of flare and damage accrual after discontinuation of low-dose glucocorticoids (GCs) in SLE.
METHODS
We performed a comprehensive literature search of the PubMed, Embase, Cochrane Library and Scopus databases from inception to July 2020 for studies concerning relapses/damage accrual in SLE patients. Pooled incidence rates of flare and time to flare with their 95% CIs after GC withdrawal were calculated. The summary risk ratio (RR) and 95% CI of flare/organ damage accrual risk were computed using a random- or fixed-effects model.
RESULTS
A total of 738 SLE patients with GC discontinuation in 17 publications were eligible for the final analysis. In the primary meta-analysis, the pooled incidence of flare was 24% (95% CI 21, 27) and 13% (95% CI 8, 18) for global and major flares, respectively. Pooled time to flare was 21.08 months (95% CI 9.32, 32.85). In the secondary meta-analysis, GC discontinuation showed an increased risk of flare compared with GC continuation [RR 1.38 (95% CI 1.01, 1.89)], but the risk of major flares was not increased [RR 1.77 (95% CI 0.40, 7.83)]. Moreover, GC withdrawal was associated with a borderline risk reduction in the SLICC/ACR damage index increase compared with GC continuation [RR 0.64 (95% CI 0.38, 1.09)].
CONCLUSION
GC discontinuation leads to a slightly increased risk of flare, however, no increase in major flare and a borderline reduction of risk in further damage in SLE patients. Baseline screening for candidate patients and long-term follow-up after GC withdrawal are needed to reliably evaluate the organ damage increase.
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