Lupus & antiphospholipid syndrome
Combination of clinical factors predicts successful glucocorticoid withdrawal in systemic lupus erythematosus (SLE): results from a multicentre, retrospective cohort study
Authors' conclusion
Low or absent disease activity, slow tapering and hydroxychloroquine use minimise the risk of flares, facilitating GC discontinuation-a major goal in SLE.
Study context
- Population
- Patients with active SLE (PGA ≥1.5 and/or SLEDAI-2K ≥6) who received glucocorticoid (GC) as part of treatment intensificationmedian follow-up 60 months
- Participants
- 324 patients
- Exposure
- GC withdrawal vs no GC withdrawal; predictors of flare after GC discontinuation
- Withdrawersn = 220
- Outcome
- SELENA-SLEDAI flares (overall and severe) and their predictors
Methodological detailsmulticentre, survival and generalised linear models, random survival forests
- Multicentre
- Survival and generalised linear models
- Random survival forests
Main finding
As reported in the abstract
1 year
Withdrawers
- 1-year risk of overall flares
- 50%
- 1-year risk of severe flares
- 25%
Withdrawers
1-year risk of overall flares50%
1-year risk of severe flares25%
Withdrawers vs Non-withdrawersHazard ratio (95% CI)
Overall flares
1.48(1.12–1.96)
Severe flares
1.52(1.03–2.25)
Observational data: associations, not effects.
Further findings
Severe flares by disease state at GC cessation
| HR (CI) | ||
|---|---|---|
| Remission (DORIS) | 0.23 (0.12–0.43) | |
| LLDAS (excluding remission) | 0.30 (0.18–0.50) | |
| 0.10.31310Hazard ratio (log scale) |
Flares with HCQ
| Estimate | ||
|---|---|---|
| HCQ | HR (total flares) 0.37 (CI 0.26–0.53) | |
| HCQ | HR (severe flares) 0.33 (CI 0.21–0.52) | |
| 0.20.5125Ratio (log scale) |
Severe flare-free outcome with slow prednisone tapering
| HR (CI) | ||
|---|---|---|
| Prednisone tapering from 7.5 mg/day to 0 over >6 months | 0.57 (0.37–0.90) | |
| 0.20.5125Hazard ratio (log scale) |
| Outcome | Estimate | |
|---|---|---|
| Combination of DORIS/LLDAS, HCQ use and slow GC taperingThis combinationvs Non-withdrawers | IRR (damage) 0.31 (95% CI 0.08–0.84) | |
| Combination of DORIS/LLDAS, HCQ use and slow GC taperingThis combinationvs Non-withdrawers | IRR (flares) 0.52 (95% CI 0.18–1.16) | |
| 0.050.21520Ratio (log scale) |
- Combination of DORIS/Lupus Low Disease Activity State (LLDAS), HCQ use and slow GC tapering — Coexistence reduced overall flares
- ≈25 fold
- Combination of DORIS/LLDAS, HCQ use and slow GC tapering — Coexistence reduced severe flares
- ≈50 fold
Severe flares by disease state at GC cessation
- Each additional month in targets provided further protection
Flares with HCQ
- Mycophenolate and azathioprine reduced overall flares
Original publication
Combination of clinical factors predicts successful glucocorticoid withdrawal in systemic lupus erythematosus (SLE): results from a multicentre, retrospective cohort study. RMD Open. Published 6 January 2025. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →