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Clinical Challenges in SLE: Glucocorticoids—How Much Is Too Much?

  |  Issue: September 2022  |  

When Dr. Ruiz-Irastorza et al. compared their patients with historical controls over the last 20 years, they found their glucocorticoid scheme reduced glucocorticoid-related damage and cardiovascular disease without compromising SLE disease control.10 “Our patients must not pay the price of glucocorticoid toxicity to get SLE well controlled,” said Dr. Ruiz-Irastorza. We now have ways to treat the disease in a different manner.”

In Sum

Glucocorticoids are a necessary yet toxic component of SLE treatment, and tapering schemes differ by institution and individual prescriber. Dr. Ruiz-Irastorza and colleagues shared captivating data from their experience treating patients with brief methylprednisolone pulses and more rapid, lower dose tapering prednisone schemes. In the future, we hope further studies will confirm the safety and efficacy of this approach and spare our patients from glucocorticoid-related damage.

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Samantha C. Shapiro, MD, is an academic rheumatologist and an affiliate faculty member of the Dell Medical School at the University of Texas at Austin. She is also a member of the ACR Insurance Subcommittee.

References

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  2. Buttgereit F, Straub RH, Wehling M, Burmester G-R. Glucocorticoids in the treatment of rheumatic diseases: An update on the mechanisms of action. Arthritis Rheum. 2004 Nov;50(11):3408–3417.
  3. Ugarte-Gil MF, Mak A, Leong J, et al. Impact of glucocorticoids on the incidence of lupus-related major organ damage: A systematic literature review and meta-regression analysis of longitudinal observational studies. Lupus Sci Med. 2021 Dec;8(1):e000590.
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  7. Ruiz-Irastorza G, Ruiz-Estevez B, Lazaro E, et al. Prolonged remission in SLE is possible by using reduced doses of prednisone: An observational study from the Lupus-Cruces and Lupus-Bordeaux inception cohorts. Autoimmun Rev. 2019 Sep;18(9):102359.
  8. Ruiz-Irastorza G, Dueña-Bartolome L, Dunder S, et al. Eurolupus cyclophosphamide plus repeated pulses of methyl-prednisolone for the induction therapy of class III, IV and V lupus nephritis. Autoimmun Rev. 2021 Oct;20(10):102898.
  9. Rovin BH, Teng YKO, Ginzler EM, et al. Efficacy and safety of voclosporin versus placebo for lupus nephritis (AURORA 1): A double-blind, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet. 2021 May 29;397(10289):2070–2080.
  10. Ruiz-Arruza I, Lozano J, Cabezas-Rodriguez I, et al. Restrictive use of oral glucocorticoids in systemic lupus erythematosus and prevention of damage without worsening long-term disease control: An observational study. Arthritis Care Res (Hoboken). 2018 Apr;70(4):582–591.

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