Prevalence and factors associated with glucocorticoids (GC) use in systemic sclerosis (SSc): a systematic review and meta-analysis of cohort studies and registries

Glucocorticoids (GC) represent a mainstay in the therapeutical strategies of many autoimmune diseases, but their role in systemic sclerosis (SSc) is controversial. The main objective of this review is to assess the extent of and the factors associated with GC use in SSc patients, taking into account data from cohort studies and registries. We performed a search in MEDLINE databases updated to April 2013. The pooled prevalence and factors associated with GC utilization in both SSc patients collectively considered and in any of the two subsets of the disease were calculated. The pooled prevalence was 0.36 (95 % confidence interval (CI) 0.28-0.43) for overall sample. In six studies, data about the GC prescription in the two different subsets of the disease were available. The pooled prevalence was 0.52 (95 % CI 0.49-0.55) in diffuse and 0.33 (95 % CI 0.31-0.35) in limited cutaneous disease patients. Five papers reporting data about the dose of GC prescribed showed a pooled prevalence of 0.89 (95 % CI 0.87-0.91) for a daily dose of <15 mg of prednisone equivalent. Huge heterogeneity was identified across studies (I (2) > 75 %). No significant correlation was detected between the extent of GC utilization and either the percentage of concomitant immunosuppressants intake (p = 0.347), diffuse subset (p = 0.720) or female sex (p = 0.913). Despite the limited evidence for their effectiveness, GC are frequently prescribed in SSc patients, mostly in those with the diffuse subset. The variability in the extent of their utilization in different centres is considerable and suggests the need to develop treatment recommendations.