Glucocorticoids in systemic lupus erythematosus

Abstract

Glucocorticoids (GCs) remain the cornerstone of the treatment of systemic lupus erythematosus (SLE), despite advances in immunosuppressive drugs, therapeutic protocols and development of new drugs. GCs rapidly control disease activity in mild as well as in severe disease, although these effects might not be maintained over time. The majority of SLE patients have received GC treatment; in some cohorts up to 80% of patients continue this treatment indefinitely as 'maintenance' therapy, at low doses of less than 7.5 mg/day. The positive effects of GCs are diminished by adverse effects, particularly at high doses. The cumulative dose of GCs clearly is related to adverse effects. Several unresolved issues in GC treatment of SLE include the optimal doses to be used in induction and maintenance, and in particular how high the dose for how long. It remains unclear whether GCs should be continued indefinitely and, if not, when and how this treatment should be discontinued. Both clinical trials and observational data will help to clarify these issues.