Cumulative Burden of Glucocorticoid-related Adverse Events in Patients with Systemic Lupus Erythematosus: Findings from a 12-year Longitudinal Study
Cumulative Burden of Glucocorticoid-related Adverse Events in Patients with Systemic Lupus Erythematosus: Findings from a 12-year Longitudinal Study
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DOI：
10.3899/jrheum.160214
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发表时间：
2018-01-01
影响因子：
3.9
通讯作者：
Hsiao, Fei-Yuan
中科院分区：
文献类型：
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作者：
Chen, Hung-Lin;Shen, Li-Jiuan;Hsiao, Fei-Yuan
目标。这项以人群为基础的研究的目的是调查中国人系统性红斑狼疮(SLE)队列中与纵向使用全身糖皮质激素(GC)相关的不良事件(AE)。我们的研究对象是2001至2012年间从台湾国家健康保险研究资料库(NHIRD)获得至少一张全身性GC处方的18岁及以上新诊断SLE患者。以各受试者全身GC的最早处方日期为指标日。对于每个受试者，我们计算了指数日期后每90天每个患者的平均强的松龙当量剂量和GC使用的药物持有率(MPR)。在随访期间被诊断为AE(由国际疾病分类-9-临床修改诊断代码定义)的患者也从NHIRD被确定。应用经倾向评分调整的广义估计方程来检验纵向使用GC与预先指定的AE(肌肉骨骼、胃肠道、眼科、感染性、心血管、神经精神科、代谢和皮肤科疾病)风险之间的关联。我们确定了11,288名SLE患者(平均随访：6.28年)。高剂量和高MPR的GC与骨坏死风险增加相关[调整后的OR(AOR)2.87-9.09]。在患骨质疏松症(AOR 1.71-3.67)、细菌感染(AOR 2.12-3.89)、库欣戈德综合征(AOR 6.51-62.03)和睡眠障碍(AOR 1.42-3.59)方面也有类似的结果。据我们所知，这是第一项研究表明，在全国性的亚洲SLE队列中，纵向使用GC的剂量和强度都与AE的风险有关。
Objective. The aim of this population-based study is to examine the adverse events (AE) associated with longitudinal systemic glucocorticoid (GC) use among an ethnic Chinese systemic lupus erythematosus (SLE) cohort.Methods. Our study subjects were patients with newly diagnosed SLE aged 18 and older who received at least 1 prescription of systemic GC between 2001 and 2012 from Taiwan's National Health Insurance Research Database (NHIRD). The earliest prescription date of systemic GC for each subject was defined as the index date. For each subject, we calculated the average prednisolone-equivalent dose and the medication possession ratio (MPR) of GC use every 90 days for each patient after the index date. Patients with a diagnosis of AE (defined by the International Classification of Diseases-9-Clinical Modification diagnosis code) during the followup were also identified from the NHIRD. Generalized estimating equations adjusted for propensity score were applied to examine the association between longitudinal GC use and risks of prespecified AE (musculoskeletal, gastrointestinal, ophthalmologic, infectious, cardiovascular, neuropsychiatric, metabolic, and dermatologic diseases).Results. We identified 11,288 patients with SLE (mean followup: 6.28 yrs). Higher doses and higher MPR of GC were associated with increased risk of osteonecrosis [adjusted OR (aOR) 2.87-9.09]. Similar results were found regarding the risk of osteoporosis (aOR 1.71-3.67), bacterial infection (aOR 2.12-3.89), Cushingoid syndrome (aOR 6.51-62.03), and sleep disorder (aOR 1.42-3.59).Conclusion. To our knowledge, this is the first study to show that the dose and intensity of longitudinal use of GC were both associated with risk of AE among a nationwide Asian SLE cohort.