{
  "abstract": "Objectives We examined the association between organ damage in systemic lupus erythematosus (SLE) and different patterns of glucocorticoid (GC) dosing.Methods We studied a nationwide cohort of individuals with newly diagnosed SLE 2006-2022 with follow-up data until January 2024 through a linkage of Swedish national registers. Long-term oral GC usage was evaluated to identify which dosing patterns had the strongest association with organ damage overall, and specific domains including ocular damage, cardiovascular damage, peripheral vascular damage, gastrointestinal damage, diabetes, and malignancy. We used a data driven method (weighted cumulative exposure models) to estimate the weights of the average daily dose at different time points using flexible cubic splines and determine the relative importance of exposure for the risk of organ damage accrual, adjusted for confounders. Based on the model, GC dosing patterns over the preceding 3 years were compared, contrasting different average daily doses (2.5, 5, 7.5, 10 mg).Results The cohort included 3749 patients with newly diagnosed SLE (82.1% female, median age 48.0 years). The increased risk of first overall organ damage associated with GC dosing was similar when incorporating doses during the preceding 2 and 3 years, with an adjusted hazard ratio (HR) of 1.42 (95%CI 1.33-1.51) and 1.44 (1.34-1.53), respectively, comparing 5 mg/day with non-users. GC dose during the preceding 1 year also showed a strong association with organ damage (adjusted HR=1.32 [95%CI 1.25-1.40] for 5 mg/day vs. non-users). For cardiovascular damage we found dose patterns over the past 3 years to substantially contribute to the increased risk. Compared to non-use, an average daily GC dose of 5 mg/day over the preceding 3, 2, or 1 years were associated with an adjusted HR (95%CI) for cardiovascular damage of 1.57 (1.31-1.8), 1.47 (1.24-1.65), and 1.18 (0.99-1.36), respectively.Conclusions The total increased risk of organ damage in SLE associated with long-term oral GC use is only seen when dosing during the preceding 2 years is incorporated, and for cardiovascular damage in particular it should be extended to dosing during the preceding 3 years.",
  "authors": [
    {
      "affiliations": [
        "Karolinska Institutet – Department of Medicine Solna, Clinical Epidemiology Division, Stockholm, Sweden"
      ],
      "name": "Annica Dominicus"
    },
    {
      "affiliations": [
        "Karolinska Institutet – Department of Medicine Solna, Clinical Epidemiology Division, Stockholm, Sweden"
      ],
      "name": "Álvaro Gomez"
    },
    {
      "affiliations": [
        "Karolinska Institutet – Department of Medicine Solna, Clinical Epidemiology Division, Stockholm, Sweden"
      ],
      "name": "Ngoc V Nguyen"
    },
    {
      "affiliations": [
        "Karolinska University Hospital, Karolinska Institutet – Department of Medicine Solna, Division of Rheumatology, Stockholm, Sweden"
      ],
      "name": "Karin B Sporre"
    },
    {
      "affiliations": [
        "Karolinska University Hospital, Karolinska Institutet – Department of Medicine Solna, Division of Rheumatology, Stockholm, Sweden"
      ],
      "name": "Francesca Faustini"
    },
    {
      "affiliations": [
        "Karolinska University Hospital, Karolinska Institutet – Department of Medicine Solna, Division of Rheumatology, Stockholm, Sweden"
      ],
      "name": "Elisabet Svenungsson"
    },
    {
      "affiliations": [
        "Karolinska Institutet – Department of Medicine Solna, Clinical Epidemiology Division, Stockholm, Sweden"
      ],
      "name": "Elizabeth V Arkema"
    }
  ],
  "title": "PO:03:093 Oral glucocorticoid dose patterns and organ damage in systemic lupus erythematosus – a nationwide cohort study",
  "uid": "4cfa5bb1-e39f-5fde-b134-6dcd239dae64"
}