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Published on: December 9, 2015
Effects of glucocorticoid withdrawal on relapse risk in systemic lupus erythematosus: A systematic review and
Sicheng Huang1, Yimeng Jia1, Yuelun Zhang2
1Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), State Key Laboratory of Complex Severe and Rare Diseases, The Ministry of Education Key Laboratory, Beijing 100730, China.
Abstract:
Whether discontinuing glucocorticoids (GCs) increases relapse risk in systemic lupus erythematosus (SLE) remains a critical consideration. A systematic review and meta-analysis of 10 randomized clinical trials (RCTs) and observational cohort studies was conducted to evaluate relapse outcomes after GC withdrawal versus maintenance. RCTs showed that GC withdrawal led to a higher overall relapse rate (risk difference [RD] 0.13; 95% CI 0.03-0.23; p = 0.008) and an increased rate of severe relapses (RD 0.02; 95% CI 0.00-0.05; p = 0.04), whereas observational cohorts found similar relapse rates between withdrawal and maintenance and demonstrated non-inferiority within a 15% margin. These findings indicate that GC withdrawal should be approached with caution in patients with SLE, and more research is needed to identify which patients can safely discontinue GC. This review should help guide the choice of maintenance therapy and highlights the need for personalized tapering strategies to optimize long-term outcomes in SLE management.
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