Recent glucocorticoid dose patterns linked to organ damage in Swedish SLE cohort

A nationwide Swedish register-linked cohort study examined how oral glucocorticoid dose patterns relate to organ damage in systemic lupus erythematosus (SLE). Researchers included 3,749 patients diagnosed during 2006–2022, with follow-up through January 2024; 82.1% were female and the median age was 48 years. Pharmacy dispensations were used to estimate exposure, and confounder-adjusted weighted cumulative exposure models assessed the relative contribution of doses at different time points.

The association between glucocorticoid dosing and first organ damage overall was well captured by exposure during the preceding two years: the adjusted hazard ratio reported for 5 mg/day was 1.42 (95% CI 1.31–1.53). Exposure during the preceding year also captured much of the association, with an adjusted hazard ratio of 1.34 (95% CI 1.23–1.42). For cardiovascular damage, dose patterns over the preceding three years contributed substantially to the associated increased risk.

The authors conclude that evaluations of overall organ damage should consider at least the previous year of glucocorticoid exposure, extending assessment of exposure and disease activity to three years for cardiovascular damage. These observational findings do not establish causality. Dispensation-based exposure does not directly confirm medication use, and the abstract alone provides insufficient detail to assess residual confounding, including the role of disease activity.