Glucocorticoids discontinuation in systemic lupus erythematosus: a single-centre study

To investigate the relapse rate of SLE patients after glucocorticoids (GCs) withdrawn, assess the risk factors associated with disease relapse and clarify the outcome of patients with relapse.

Data of SLE patients who discontinued GC during 2017-2022 were included. Cox regression model was used to estimate the hazard ratio for different factors contributing to lupus relapse. Kaplan-Meier model was used to assess the cumulative relapse rate. For those who relapsed, the proportion of patients regaining remission or lupus low disease activity state (LLDAS) was tracked, and factors associated with remission were analysed.

Totally 217 SLE patients were included, of whom 166 experienced disease relapse. The non-relapse rates were 57.3% at 1 year, 19.6% at 3 years and only 7.8% at 5 years after GC withdrawal. Multivariable Cox regression analysis showed self-discontinuation, prior renal or pulmonary impairment or positive anti-dsDNA antibody were independent predictors of SLE relapse. Of the relapsed patients, 21.1% had achieved remission and 54.2% had achieved LLDAS at 12 months of follow-up. Those with high SLEDAI-2K score, anaemia, hypocomplementaemia as well as positive anti-dsDNA or anti-Sm antibody had lower remission rates.

Most SLE patients have difficulty maintaining prolonged stabilization after discontinuing GC and regain remission within a year of relapse. Before discontinuing GC, risk factors associated with recurrence of SLE need to be assessed.