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

Area of Science:

• Rheumatology
• Immunology
• Clinical Medicine

Background:

• Systemic Lupus Erythematosus (SLE) management often involves glucocorticoids (GCs).
• Discontinuation of GCs can lead to disease flares or relapse.
• Understanding relapse rates and risk factors is crucial for patient management.

Purpose of the Study:

• To determine the relapse rate in SLE patients after discontinuing GCs.
• To identify risk factors associated with SLE relapse post-GC withdrawal.
• To evaluate the outcomes for patients experiencing relapse.

Main Methods:

• Retrospective analysis of 217 SLE patients who discontinued GCs between 2017-2022.
• Cox regression and Kaplan-Meier models to assess relapse rates and predictors.
• Analysis of remission and Lupus Low Disease Activity State (LLDAS) achievement in relapsed patients.

Main Results:

• 166 out of 217 patients (76.5%) relapsed after GC withdrawal.
• Cumulative non-relapse rates were 57.3% at 1 year, 19.6% at 3 years, and 7.8% at 5 years.
• Independent predictors of relapse included self-discontinuation, prior renal/pulmonary impairment, and positive anti-dsDNA antibodies. 21.1% achieved remission and 54.2% achieved LLDAS within 12 months post-relapse.

Conclusions:

• Prolonged stabilization after GC withdrawal is challenging for most SLE patients.
• Early assessment of risk factors for relapse is essential before GC discontinuation.
• While many patients regain remission or LLDAS, specific clinical and serological factors are associated with lower remission rates.