Abstract Text: Introduction Glucocorticoids are used to treat flare-ups and provide rapid symptomatic relief in patients with systemic lupus erythematosus (SLE). However, long-term use of glucocorticoids is associated with numerous adverse events ranging from mild to severe. The objective of this study is to evaluate after real-life follow-up the incidence of side effects related to the long-term use of glucocorticoids in SLE patients and to assess the efficacy of immunosuppressive therapies. Methods We included 83 patients followed at the University Hospitals of Geneva and fitting the EULAR/ACR 2019 criteria for SLE. Clinical and biological data were collected from computerized records. Statistical analyses were performed with R software. Results 87% of the included patients were women with a median age of 34 years. The median initial dose of prednisone was 40 mg/d. Side effects occurred in 86.75%. Immunosuppressive therapies were used in 74.69%. Long-term glucocorticoid-related side effects occurred in 86.75%. The most common adverse events were weight gain (30%), infections (23.17%), and osteoporosis (15.66%). Patients with multiple risk factors and cardiovascular comorbidities at the time of SLE diagnosis were most likely to develop adverse events. Survival analyses (Kaplan-Meier), between-group comparisons (t-test), and correlation analyses (Spearman) showed a benefit on SLE disease activity (decreased number/incidence of relapses; decreased SLEDAI score) of long-term immunosuppressive therapy compared with long-term glucocorticoid use alone. Conclusion This real-life study confirms the harmfulness of glucocorticoids in long-term use with a dose-dependent effect depending on comorbidities. Immunosuppressive treatments reduce the incidence of adverse effects while controlling SLE evolution.
