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Risk of flare and damage accrual after tapering glucocorticoids in modified serologically active clinically quiescent patients with systemic lupus erythematosus: a multinational observational cohort study. 2024
Yasuhiro Katsumata, and
Eisuke Inoue, and
Masayoshi Harigai, and
Jiacai Cho, and
Worawit Louthrenoo, and
Alberta Hoi, and
Vera Golder, and
Chak Sing Lau, and
Aisha Lateef, and
Yi-Hsing Chen, and
Shue-Fen Luo, and
Yeong-Jian Jan Wu, and
Laniyati Hamijoyo, and
Zhanguo Li, and
Sargunan Sockalingam, and
Sandra Navarra, and
Leonid Zamora, and
Yanjie Hao, and
Zhuoli Zhang, and
Madelynn Chan, and
Shereen Oon, and
Kristine Ng, and
Jun Kikuchi, and
Tsutomu Takeuchi, and
Fiona Goldblatt, and
Sean O'Neill, and
Nicola Tugnet, and
Annie Hui Nee Law, and
Sang-Cheol Bae, and
Yoshiya Tanaka, and
Naoaki Ohkubo, and
Sunil Kumar, and
Rangi Kandane-Rathnayake, and
Mandana Nikpour, and
Eric F Morand, and
Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan katsumata@twmu.ac.jp.
OBJECTIVE To assess the risk of flare and damage accrual after tapering glucocorticoids (GCs) in modified serologically active clinically quiescent (mSACQ) patients with systemic lupus erythematosus (SLE). METHODS Data from a 12-country longitudinal SLE cohort, collected prospectively between 2013 and 2020, were analysed. SLE patients with mSACQ defined as the state with serological activity (increased anti-dsDNA and/or hypocomplementemia) but without clinical activity, treated with ≤7.5 mg/day of prednisolone-equivalent GCs and not-considering duration, were studied. The risk of subsequent flare or damage accrual per 1 mg decrease of prednisolone was assessed using Cox proportional hazard models while adjusting for confounders. Observation periods were 2 years and censored if each event occurred. RESULTS Data from 1850 mSACQ patients were analysed: 742, 271 and 180 patients experienced overall flare, severe flare and damage accrual, respectively. Tapering GCs by 1 mg/day of prednisolone was not associated with increased risk of overall or severe flare: adjusted HRs 1.02 (95% CI, 0.99 to 1.05) and 0.98 (95% CI, 0.96 to 1.004), respectively. Antimalarial use was associated with decreased flare risk. Tapering GCs was associated with decreased risk of damage accrual (adjusted HR 0.96, 95% CI, 0.93 to 0.99) in the patients whose initial prednisolone dosages were >5 mg/day. CONCLUSIONS In mSACQ patients, tapering GCs was not associated with increased flare risk. Antimalarial use was associated with decreased flare risk. Tapering GCs protected mSACQ patients treated with >5 mg/day of prednisolone against damage accrual. These findings suggest that cautious GC tapering is feasible and can reduce GC use in mSACQ patients.
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