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- Title
It hasn't gone away: the problem of glucocorticoid use in lupus remains.
- Authors
Apostolopoulos, Diane; Morand, Eric F.
- Abstract
The treatment of SLE remains complex, and management is constrained by a lack of safe, effective, targeted therapies. Physicians, also, are constrained by a lack of evidence-based approaches with existing agents, including glucocorticoids, utilized in the majority of patients. While Cushingoid side effects of glucocorticoids are widely recognized, emerging literature now suggests that glucocorticoid use actually contributes to harmful outcomes in SLE, over and above these effects. These studies provide a compelling case for a re-evaluation of the long-term use of glucocorticoids in SLE, focusing on minimizing glucocorticoid exposure as part of the strategy to improve long-term outcomes. In this article, we review the evidence for the harmful effects of glucocorticoids in SLE, and propose therapeutic options that reduce reliance on glucocorticoids. We propose that it is time for the lupus community to have a louder conversation about glucocorticoid use, and for any residual complacency about their risk-benefit ratio to be banished.
- Subjects
ADRENOCORTICAL hormones; HORMONE therapy; THERAPEUTIC use of glucocorticoids; HEART disease risk factors; SYSTEMIC lupus erythematosus treatment; CHRONIC diseases; CUSHING'S syndrome; DIFFUSION of innovations; CLINICAL drug trials; EXERCISE; GLUCOCORTICOIDS; LUNG diseases; MEDICAL care; MEDICAL quality control; PATIENTS; PREDNISONE; STEROIDS; UNITED States. Food &; Drug Administration; TREATMENT effectiveness; PREDNISOLONE; ANTINEUTROPHIL cytoplasmic antibodies
- Publication
Rheumatology, 2017, Vol 56, pi114
- ISSN
1462-0324
- Publication type
Article
- DOI
10.1093/rheumatology/kew406