Glucocorticoid use linked to increased mortality risk in systemic lupus erythematosus

  • Bultink IEM & al.
  • Rheumatology (Oxford)
  • 12 Jul 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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  • 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.


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