Glucocorticoid Use Linked to Increased Mortality Risk in Systemic Lupus Erythematosus

Sarfaroj Khan 

July 29, 2020

Takeaway

  • Patients with systemic lupus erythematosus (SLE) had a 1.8-fold increased mortality rate compared with the general population.

  • Young age and cumulative glucocorticoid exposure were associated with an increased risk of mortality.

  • Hydroxychloroquine (HCQ) exposure was associated with a 45% reduced mortality in the lowest cumulative dosage group.

Why this matters

  • Findings warrant future studies to determine the mechanisms behind the increased mortality in SLE and develop interventions to improve survival.

Study design

  • This population-based cohort study included 4356 patients with SLE and 21,845 age- and sex-matched control participants using data from the Clinical Practice Research Datalink (CPRD; from 1987 to 2012).

  • Funding: None.

Key results

  • Patients with SLE vs control group had a 1.8-fold increased rate of all-cause mortality (adjusted HR [aHR], 1.80; 95% CI, 1.57-2.08).

  • The risk was higher in the youngest age group (18-39 years; aHR, 4.87; 95% CI, 1.93-12.3) and decreased through age groups (≥80 years; aHR, 1.07; 95% CI, 0.79-1.46).

  • The risk of mortality was slightly higher in women vs men with SLE (aHR: 1.82 [95% CI, 1.56-2.13] vs 1.68 [95% CI, 1.19-2.39]); however, this difference was not statistically significant (P=.332).

  • Cumulative glucocorticoid use was associated with an increased risk of all-cause mortality:

    • any current use (aHR, 2.60; 95% CI, 2.12-3.20);

    • 1-181 mg (aHR, 3.37; 95% CI, 2.35-4.81);

    • 181-730 mg (aHR, 2.06; 95% CI, 1.49-2.85); and

    • >730 mg (aHR, 2.66; 95% CI, 2.11-3.35).

  • HCQ use was associated with reduced mortality risk, but this association was significant only in the lowest cumulative exposure group (1-181 mg: aHR, 0.55; 95% CI, 0.31-0.98).

  • After adjustment, mortality rates for cardiovascular disease, infections, non-infectious respiratory disease and for death attributable to accidents or suicide were significantly increased in patients with SLE vs control group, whereas the mortality rate for cancer was reduced.

Limitations

  • Study did not have data on disease activity and organ damage.

Bultink IEM, de Vries F, van Vollenhoven RF, Lalmohamed A. Mortality, causes of death and influence of medication use in patients with systemic lupus erythematosus vs matched controls. Rheumatology (Oxford). 2020 Jul 12 [Epub ahead of print]. doi: 10.1093/rheumatology/keaa267. PMID: 32653901 View abstract.

This clinical summary first appeared on Univadis, part of the Medscape Professional Network.

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