title: Rate of Adverse Effects of Medium- to High-Dose Glucocorticoid Therapy in Systemic Lupus Erythematosus: A Systematic Review of Randomized Control Trials.
abstract: OBJECTIVE
  The efficacy of glucocorticoids (GCs) in treating systemic lupus erythematosus (SLE) is beyond doubt. However, GCs-related adverse effects (AEs) are multiple and serious. Despite the current available evidence suggesting to reduce daily doses of prednisone <7.5 mg/day, or even to withdraw it, in the real-life practice, it is not uncommon to see patients receiving medium doses (up to 30 mg/day prednisone or equivalent) or high doses (≥30 mg/day).
  
  
  METHODS
  We systematically reviewed the literature with a priori strategy, to assess the rate of AEs related to medium or high doses of GCs in patients with SLE, analyzing randomized control trials with at least one of the treatment groups including GCs alone at medium or high doses.
  
  
  RESULTS
  We found a rate of 9/100 patients/year for hyperglycemias/diabetes, 25/100 patients/year for infections, and 12/100 patients/year for avascular necrosis of the hip. Interestingly, when adjusting for GC dose and treatment duration, we observed no difference in terms of AEs comparing patients receiving medium versus high doses.
  
  
  CONCLUSIONS
  In the era when treat-to-target strategies have been proposed in order to control SLE disease activity, improved health-related quality of life, and reduced morbidity and mortality, using GCs in a more restrictive way should be a goal to prevent major complications in patients with SLE.
authors.affiliation: Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, S. Giovanni Bosco Hospital and University of Turin, Piazza del Donatore di Sangue 3, 10154, Turin, Italy. savino.sciascia@unito.it.|SCDU Nephrology and Dialysis, Department of Clinical and Biological Sciences, S. Giovanni Bosco Hospital, Turin, Italy. savino.sciascia@unito.it.
authors.forename: Savino
authors.initials: S
authors.lastname: Sciascia
authors.affiliation: Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Elisa
authors.initials: E
authors.lastname: Mompean
authors.affiliation: Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, S. Giovanni Bosco Hospital and University of Turin, Piazza del Donatore di Sangue 3, 10154, Turin, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Radin
authors.affiliation: Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, S. Giovanni Bosco Hospital and University of Turin, Piazza del Donatore di Sangue 3, 10154, Turin, Italy.|SCDU Nephrology and Dialysis, Department of Clinical and Biological Sciences, S. Giovanni Bosco Hospital, Turin, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Roccatello
authors.affiliation: Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Cuadrado
mesh_terms: D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy* / Q000523:psychology; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic
chemical_list: D005938:Glucocorticoids