Lupus & antiphospholipid syndrome
Predictors of a successful glucocorticoid tapering and withdrawal in an inception cohort of patients with lupus nephritis and associations with long-term outcomes and damage accrual
Authors' conclusion
Sustained CR/SLEDAI-2K≤4, membranous LN and persistent hydroxychloroquine use emerged as main predictors of shorter time to D/C, while DORIS complete remission at D/C and persistent hydroxychloroquine use predicted post-DC flares. Time to GC D/C and flares independently contributed to 10-year damage accrual.
Study context
- Population
- Patients with lupus nephritis (LN), inception cohort 1992–2021 (median follow-up: 121 months)
- Participants
- 136 patients
- Outcome
- Predictors of successful GC D/C (time to GC D/C)
Methodological detailsregression models
- Regression models
Main finding
As reported in the abstract
Composite CR and SLEDAI-2K≤4, sustainedly attained until glucocorticoid (GC) D/C: HR
1.85
p=0.016
Membranous LN: HR
1.81
p=0.01
Persistent HCQ use: HR
1.49
p=0.04
Median time to 7.5 mg/day, 5 mg/day and GC D/C (months post-diagnosis)
9, 12 and 29
Observational data: associations, not effects.
Further findings
Flare risk during tapering
- Shorter time to CR: OR
- 1.05, p=0.034
- LLDAS at tapering from 7.5 mg/day onwards: OR
- 0.23, p=0.046
Post-D/C renal flares
- DORIS complete remission at D/C: OR
- 0.20, p=0.005
- Persistent HCQ use: OR
- 0.28, p=0.031
- Neither higher initial GC dose (>40 mg/day) nor slower GC tapering prevented renal flares
Damage risk at end of follow-up
- Time to GC D/C: OR
- 1.02/month, p=0.04
- Flares: OR
- 2.08, p=0.036
Original publication
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