Lupus & antiphospholipid syndrome
Impact of low disease activity, remission, and complete remission on flares following tapering of corticosteroids and immunosuppressive therapy in patients with systemic lupus erythematous: a multinational cohort study
Main finding · Flare at next visitResult — go to the resultOdds ratio 1.24 95% CI 1.10–1.39Authors' conclusion
Tapering of corticosteroids or immunosuppressive therapy in patients with stable SLE was associated with excess flares.
Study context
- Population
- Adults ≥18 years with stable systemic lupus erythematosus (SLE) (Lupus Low Disease Activity State (LLDAS), Definitions of Remission in SLE (DORIS) remission or complete remission) in routine clinical care, 25 sites across 13 Asia-Pacific countries, 2013–2020visits analysed
- Participants
- 13,140 adults
- Exposure
- Tapering of corticosteroids or immunosuppressive therapy vs continuing the same therapy in stable SLE
- Taperingn = 3,277
- Same therapyn = 9,863reference
- Outcome
- Flare (SELENA-SLEDAI Flare Index) at the subsequent visit after drug tapering
- Follow-up
- Next visit
Methodological detailsmultinational, multicentre (25 sites, 13 Asia-Pacific countries), multivariable generalised estimating equations, Cox proportional hazard models
- Multinational
- Multicentre (25 sites, 13 Asia-Pacific countries)
- Multivariable generalised estimating equations
- Cox proportional hazard models
Main finding
Flare at next visit
Odds ratio
1.24
95% CI 1.10–1.39
P = 0.0005
Events by group
Taperingvs Same therapy
OR 1.24 (95% CI 1.10–1.39); P = 0.0005
As reported in the abstract
Observational data: associations, not effects.
Further findings
Severe flares at next visit (proportion of flares)
| Outcome | Estimate | P value | |
|---|---|---|---|
| Flare in 1 year by stable-disease state at taper initiation (vs complete remission)LLDASvs Complete remission | OR for flare 1.37 (95% CI 1.03–1.81) | P = 0.029 | |
| Time to first flare by stable-disease state at taper initiation (vs complete remission)LLDASvs Complete remission | HR for first flare 1.24 (95% CI 1.04–1.48) | P = 0.016 | |
| Time to first flare by stable-disease state at taper initiation (vs complete remission)Remissionvs Complete remission | HR for first flare 1.30 (95% CI 1.08–1.56) | P = 0.0054 | |
| 0.512Ratio (log scale) |
| Outcome | OR for flare (95% CI) | P value |
|---|---|---|
| Flare in 1 year by stable-disease state at taper initiation (vs complete remission)Remission vs Complete remission | 1.45 (1.08–1.94) | P = 0.013 |
- Flare in 1 year by stable-disease state at taper initiation (vs complete remission): LLDAS 41.1%
- Flare in 1 year by stable-disease state at taper initiation (vs complete remission): Remission 28.4%
- Flare in 1 year by stable-disease state at taper initiation (vs complete remission): Complete remission 30.5%
- Flare in 1 year by stable-disease state at taper initiation (vs complete remission): per_group counts are tapering attempts initiated in each state (of 2095), not flares
Sustained LLDAS, remission or complete remission ≥6 months before taper
- Associated with lower odds of flare at next visit, flares in 1 year, and longer time to flare
Original publication
Impact of low disease activity, remission, and complete remission on flares following tapering of corticosteroids and immunosuppressive therapy in patients with systemic lupus erythematous: a multinational cohort study. Lancet Rheumatol. Published 12 September 2023. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →