Dataset Information

The risk benefit ratio of glucocorticoids in SLE: have things changed over the past 40 years?

ABSTRACT: PURPOSE OF REVIEW:Glucocorticoids have been the mainstay of treatment in systemic lupus erythematosus for more than half a century. Despite advancements in knowledge concerning the pathophysiology of systemic lupus, the genomic/non-genomic actions of glucocorticoids, and the use of novel therapeutic agents in SLE, the burden of toxicity from glucocorticoid use remains unchanged. RECENT FINDINGS:SLE patients receiving long-term prednisone therapy are at significant risk of morbidity due to permanent organ damage and prednisone daily dosages above 6 mg have been shown to increase the risk of future organ damage by 50%. Glucocorticoid use carries a higher risk of opportunistic infections, iatrogenic osteoporosis and avascular necrosis, an increase in risk of cardiovascular events, cataracts and glaucoma, as well as psychiatric adverse effects like psychosis and manic episodes. There are limited data regarding the relative efficacy of the different glucocorticoid formulations or dosing regimens. SUMMARY:The use and dosing of glucocorticoids in SLE remains more art than science, although our knowledge regarding their complex genomic and non-genomic effects, as well as the resultant adverse effects, has greatly expanded over the past half a century.

SUBMITTER: Stojan G

PROVIDER: S-EPMC5565217 | biostudies-literature | 2017 Sep

REPOSITORIES: biostudies-literature

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The risk benefit ratio of glucocorticoids in SLE: have things changed over the past 40 years?

Stojan G G Petri M M

Current treatment options in rheumatology 20170727 3

<h4>Purpose of review</h4>Glucocorticoids have been the mainstay of treatment in systemic lupus erythematosus for more than half a century. Despite advancements in knowledge concerning the pathophysiology of systemic lupus, the genomic/non-genomic actions of glucocorticoids, and the use of novel therapeutic agents in SLE, the burden of toxicity from glucocorticoid use remains unchanged.<h4>Recent findings</h4>SLE patients receiving long-term prednisone therapy are at significant risk of morbidit ...[more]

PMID: 28840094

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Project description:Abundance-occupancy (A-O) relationships are widely documented for many organismal groups and regions, and have been used to gain an understanding of regional population and community trends. Monitoring changes in abundance and occupancy over time may be what is required to document changes in conservation status and needs for some species, communities, or areas.We hypothesize that if there is a higher proportion of declining species in one group of species compared with another (e.g., migratory species vs. permanent residents), then a consequence of that difference will be vastly different abundance-occupancy relationships. If this difference persists through time, then the resulting A-O relationships between the groups will continue to diverge.For neotropical migrants, short-distance migrants, and permanent resident birds of North America, we assess the numbers of declining species over 1969-2009. We further test for differences in the A-O relationship across these three groups, and in rates of change in abundance and occupancy separately.We find significant differences in numbers of declining species across the migratory groups, a significant decline in the A-O relationship for permanent residents, a significant increase for Neotropical migrants, and a nonsignificant decline for short-distance migrants over the 40 years. Further, abundances are not changing at different rates but occupancies are consistently greater over time for neotropical migrants versus permanent residents, likely driving the changes in A-O relationships observed.In these analyses, we documented changing A-O trends for different groups of species, over a relatively long time period for ecological studies, one of only a few studies to examine A-O relationships over time. Further, we have shown that a temporally unvarying abundance-occupancy relationship is not universal, and we posit that variability in A-O relationships is due to human impacts on habitats, coupled with variation in species' abilities to respond to human impacts.

Dataset Information

The risk benefit ratio of glucocorticoids in SLE: have things changed over the past 40 years?

Publications

The risk benefit ratio of glucocorticoids in SLE: have things changed over the past 40 years?

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