ArticleArthritis research & therapy2022
Association of low-dose glucocorticoid use and infection occurrence in systemic lupus erythematosus patients: a prospective cohort study.
Article in Arthritis research & therapy, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 2 of them syntheses that pooled it.
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Who cites it
17 citing papers in PubMed, 2 syntheses or guidelines pooled it, 28 citations in OpenAlex.
- Risk factors for infections in systemic lupus erythematosus: a meta-analysis.Immunologic research · 2025Pooled it
- Saudi National Clinical Practice Guidelines for Management of Adult Systemic Lupus Erythematosus.Current rheumatology reviews · 2025Guideline
- Prospective Quantification of Glucocorticoid Toxicity Across Dosage Ranges in Systemic Lupus Erythematosus: Insights from the Glucocorticoid Toxicity Index.Rheumatology and therapy · 2026Article
- Incidence of serious infections, herpes zoster and hepatitis B virus reactivation among patients with SLE: a cohort study using a health claims database in Japan.Lupus science & medicine · 2026Article
- The relationship between obesity and disease relapse in systemic lupus erythematosus: a retrospective cohort study using the LUNA registry.Frontiers in immunology · 2026Article
- Incidence and Risk Factors for Serious Infections in Patients with Neuromyelitis Optica Spectrum Disorder: A Claims Database Study in Japan.Neurology and therapy · 2025Article
- Peripartum maternal outcomes in individuals with systemic lupus erythematosus in a real-world electronic health record cohort.Seminars in arthritis and rheumatism · 2025Article
- Medication-related hospitalisations in patients with SLE.Lupus science & medicine · 2025Article
- Review
- Use of Glucocorticoids in SLE: A Clinical Approach.Mediterranean journal of rheumatology · 2024Review
- SLESIS-R: an improved score for prediction of serious infection in patients with systemic lupus erythematosus based on the RELESSER prospective cohort.Lupus science & medicine · 2024Review
- Glucocorticoid treatment in SLE is associated with infections, comorbidities and mortality-a national cohort study.Rheumatology (Oxford, England) · 2024Article
- Pragmatic targets for moderate/severe SLE and their implications for clinical care and trial design: sustained DORIS or LLDAS for at least 6 months is sufficient while their attainment for at least 24 months ensures high specificity for damage-free progression.Annals of the rheumatic diseases · 2024Article
- Article
- Epidemiology of systemic lupus erythematosus in Korea.Journal of rheumatic diseases · 2023Review
- Tuberculosis remains a leading contributor to morbidity due to serious infections in Indian patients of SLE.Clinical rheumatology · 2023Article
- Protective effect of hydroxychloroquine on infections in patients with systemic lupus erythematosus: an observational study using the LUNA registry.Frontiers in immunology · 2023Observational
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Authors and funding
14 authors at 11 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundInfection is a major cause of mortality in patients with systemic lupus erythematosus (SLE). Therefore, minimizing the risk of infection is an important clinical goal to improve the long-term prognosis of SLE patients. Treatment with ≥7.5 mg prednisolone (PSL) or equivalent has been reported to increase the risk of infections. However, it remains unclear whether <7.5 mg PSL or equivalent dose affects the risk of infection in SLE patients. This study evaluated the association between the occurrence of infection in patients with SLE and low-dose glucocorticoid (GC) usage, especially <7.5 mg PSL or equivalent, to explore the GC dose that could reduce infection occurrence.
methodsThis prospective cohort study included patients from the Japanese multicenter registry of patients with SLE (defined as ≥4 American College of Rheumatology 1997 revised criteria) over 20 years of age. The PSL dose was categorized as PSL 0-2.5, 2.6-5.0, 5.1-7.5, and 7.6-15.0 mg. The primary outcome was infection requiring hospitalization. We conducted a multivariable analysis using time-dependent Cox regression analysis to assess the hazard ratio of infection occurrence compared with a dose of 0-2.5 mg PSL or equivalent in the other three PSL dose groups. Based on previous reports and clinical importance, the covariates selected were age, sex, and concurrent use of immunosuppressants with GC. In addition, two sensitivity analyses were conducted.
resultsThe mean age of the 509 SLE patients was 46.7 years; 89.0% were female, and 77.2% used multiple immunosuppressants concomitantly. During the observation period, 52 infections requiring hospitalization occurred. The incidence of infection with a PSL dose of 5.0-7.5 mg was significantly higher than that in the PSL 0-2.5 mg group (adjusted hazard ratio: 6.80, 95% confidence interval: 2.17-21.27). The results of the two sensitivity analyses were similar.
conclusionsOur results suggested that the use of 5.0-7.5 mg PSL or equivalent could pose an infection risk in SLE patients. This finding indicates that PSL dose should be reduced to as low as possible in SLE patients to avoid infection.
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