Session Information
Date: Monday, November 6, 2017
Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment Poster II: Damage and Comorbidities
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose:
Atherosclerosis in SLE results from a complex interplay between traditional risk factors, SLE-specific factors, chronic inflammation and multifaceted effects of SLE therapeutics. In particular, corticosteroids may exert a double-edged effect by increasing traditional risk factors on one hand and inhibiting the inflammatory process on the other. In this meta-analysis, we aim to determine the association between corticosteroids and subclinical atherosclerosis in SLE patients and investigate the influence of strength, duration and cumulative dose of steroids.
Methods:
A comprehensive literature search was conducted in Cochrane Library, Scopus, MEDLINE, PubMed and EMBASE for articles published in English from January 1985 through June 2016 in adult age group. Studies were eligible if they presented the dose of steroid administered to the SLE group and used mean CIMT as evaluated by high-resolution ultrasound (surrogate marker of subclinical atherosclerosis). Two independent reviewers performed study selection and data extraction. All articles with multiple publications were considered for data extraction but only one was used for final analysis. The required data to estimate the effect-sizes associated with each study was extracted. Using Hedges’ random-effect model, the estimated effect-sizes were pooled together. Heterogeneity was explored using subgroup analysis and meta-regression technique. Publication bias was tested using funnel plot and Eggers test.
Results:
Out of 254 citations, 24 studies were eligible. Disease characteristics and quality score of the studies are shown in Table 1. The pooled effect size showed statistically significant increase in subclinical atherosclerosis in SLE patients (SMD=0.821, P=0.000; 95% CI, 0.512 to 1.22). In a univariate meta-regression model, corticosteroid consumption significantly increased the risk of subclinical atherosclerosis in SLE patients (B=0.018, P= 0.027; 95% CI, 0.002 to 0.035). Result also showed, there was insignificant relationship between the duration as well as cumulative dose and the risk of subclinical atherosclerosis in SLE patient. Subgroup analysis showed that the above association of corticosteroid and subclinical atherosclerosis in SLE patients is not affected by the dose of the steroid.
Conclusion:
Our findings concluded that corticosteroids increase the risk of early atherosclerosis in SLE patients. We also found that subclinical atherosclerosis is not influenced by the strength, duration or cumulative dose of steroids. The biggest challenge to this analysis is the heterogeneity of the studies included. Further research is needed to better understand the adjusted effect of SLE disease activity in the role of steroids in subclinical atherosclerosis.
Table 1.
|
Study |
Size case |
Size control |
Age (y) (case) |
Age(y) (control) |
SLE duration |
Steroid Average Dose (mg/d) |
Steroid Dosage |
Steroid Consumption (%) |
SLEDA[i] |
NOS[ii] |
||
|
1 |
Abdel-Wahab 2013 |
20 |
20 |
25.6 |
29.2 |
5.2 |
NA[iii] |
H[iv] |
100 |
23.6 |
7 |
|
|
2 |
Ajeganova 2015 |
111 |
111 |
48.6 |
48.8 |
9 |
4.3 |
L[v] |
60.4 |
2 |
7 |
|
|
3 |
Cacciapaglia 2009 |
33 |
33 |
47 |
45 |
13 |
NA |
L |
94 |
14.4 |
7 |
|
|
4 |
Colombo 2009 |
80 |
80 |
42.6 |
40.1 |
15 |
NA |
M[vi] |
100 |
2.8 |
6 |
|
|
5 |
Elshishtawy 2012 |
50 |
40 |
23.06 |
23.36 |
2.29 |
19.9 |
M |
100 |
28.16 |
6 |
|
|
6 |
Gheita 2012-13 |
92 |
30 |
30.18 |
28 |
5.83 |
13.91 |
M |
91.3 |
8.585 |
7 |
|
|
7 |
Gheita 2012 |
45 |
30 |
26.13 |
27.37 |
3.68 |
22.33 |
H |
100 |
7.31 |
6 |
|
|
8 |
Ghosh 2009 |
60 |
38 |
31 |
34 |
5 |
9 |
M |
86.6 |
4 |
7 |
|
|
9 |
Jackson 2006 |
32 |
33 |
47.5 |
48 |
13 |
3.6 |
L |
60 |
1.75 |
7 |
|
|
10 |
Jung 2014 |
102 |
52 |
38.8 |
38.1 |
6.5 |
2.6 |
L |
73.5 |
4.4 |
8 |
|
|
11 |
Leeuw 2007 |
55 |
55 |
43 |
43 |
12 |
7.5 |
M |
42 |
2 |
7 |
|
|
12 |
Mak 2011 |
55 |
55 |
40 |
40 |
4.5 |
13.28 |
M |
87 |
7 |
9 |
|
|
13 |
Nowak 2012 |
16 |
13 |
44.4 |
43.8 |
6.5 |
NA |
M |
87.5 |
10 |
7 |
|
|
14 |
Ozgen 2011 |
22 |
29 |
34 |
38 |
4.1 |
7.1 |
L |
91 |
8 |
7 |
|
|
15 |
Ozgen 2011 |
26 |
29 |
34 |
38 |
3.8 |
8.3 |
M |
84.6 |
8.3 |
8 |
|
|
16 |
Raafat 2014 |
36 |
36 |
27.9 |
28.1 |
4.1 |
24.5 |
H |
100 |
15.1 |
7 |
|
|
17 |
Roman 2003 |
197 |
197 |
44 |
44 |
12.1 |
10 |
M |
90 |
4 |
8 |
|
|
18 |
Sato 2007 |
39 |
39 |
5.1 |
5.1 |
19 |
9.4 |
M |
100 |
1.85 |
7 |
|
|
19 |
Shang 2008 |
32 |
32 |
46 |
43 |
11 |
8.6 |
M |
93.75 (94) |
1 |
7 |
|
|
20 |
Smrzova 2013 |
63 |
24 |
38.38 |
31 |
11.91 |
14.9 |
M |
97 |
7.22 |
7 |
|
|
21 |
Somers 2012 |
95 |
38 |
37.6 |
39.3 |
NA |
9.2 |
M |
62.1 |
4 |
8 |
|
|
22 |
Valdivielso 2008 |
26 |
21 |
34 |
35 |
NA |
5.11 |
L |
61 |
5.58 |
6 |
|
|
23 |
Valer 2013 |
100 |
50 |
41.54 |
41.4 |
4.25 |
19.47 |
M |
81 |
4 |
8 |
|
|
24 |
Zhang 2009 |
111 |
40 |
34.4 |
34.5 |
9.4 |
12.34 |
M |
100 |
6 |
8 |
|
[i] SLE Disease Activity Index
[ii] Newcastle–Ottawa Scale
[iii] Not available
[iv] High doe
[v] Low dose
[vi] Medium dose
To cite this abstract in AMA style:
Rajabirostami E, Newman K, Panginikkod S, Mohammadiankhansari S, Mehri N, Habibi R, Jain M. Role of Corticosteroids in Subclinical Atherosclerosis in SLE: A Systematic Review and Meta-Analysis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/role-of-corticosteroids-in-subclinical-atherosclerosis-in-sle-a-systematic-review-and-meta-analysis/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/role-of-corticosteroids-in-subclinical-atherosclerosis-in-sle-a-systematic-review-and-meta-analysis/