A RECENT study has identified a combination of clinical factors that can significantly reduce the risk of flares in systemic lupus erythematosus (SLE) patients discontinuing glucocorticoids (GC). These findings provide critical insights into safe and effective steroid withdrawal, aligning with European recommendations to minimise long-term damage from prolonged GC use.
The multicentre retrospective cohort study followed 324 SLE patients over a median of five years. Researchers analysed predictors of successful GC discontinuation, focusing on factors that mitigated the risk of overall and severe disease flares.
The study found that patients who tapered steroids while in remission or Lupus Low Disease Activity State (LLDAS) had significantly lower flare risks. Each additional month in these states further reduced the likelihood of severe flares (HR: 0.23 for remission and 0.30 for LLDAS). Hydroxychloroquine use was also strongly protective, cutting the risk of total and severe flares by 63% and 67%, respectively.
Slow GC tapering, from 7.5 mg/day to 0 over more than six months, improved outcomes, with patients experiencing fewer severe flares (HR: 0.57) and less long-term damage. The combination of remission/LLDAS, hydroxychloroquine, and gradual tapering reduced the risk of flares by up to 50-fold compared to non-withdrawers.
“This study underscores the importance of strategic glucocorticoid tapering, supported by low disease activity and hydroxychloroquine, in achieving safe steroid withdrawal,” the researchers stated.
These findings offer actionable guidance for clinicians aiming to reduce steroid dependency in lupus patients while minimising the risk of relapse.
Aleksandra Zurowska, EMJ
Reference
Katechis S et al. Combination of clinical factors predicts successful glucocorticoid withdrawal in systemic lupus erythematosus (SLE): results from a multicentre, retrospective cohort study. RMD Open. 2025;11:e005118.
