A NEW study has shown that tapering glucocorticoid steroids (GS) can be done without increasing the risk of flare for patients with systemic lupus erythematosus (SLE) who are in a modified serologically active clinically quiescent (mSACQ) state.
Long-term GC therapy has been associated with potential detrimental effects, including irreversible organ damage and, a previous meta-analysis on the risk of flare associated with GC withdrawal in SLE, indicated an increased risk of flare in mSACQ patients post GC withdrawal. This study aimed to test a protocol of gradual tapering of GCs that could reduce risk of flare and damage accrual.
The research, led by Yasuhiro Katsumata, Tokyo Women’s Medical University School of Medicine, Japan, analysed data prospectively collected from 2013 to 2020 in a 12-country longitudinal SLE cohort study. The 1850 patients followed were in an mSACQ state, defined as having serological activity without clinical activity and being treated with ≤7.5 mg/day of prednisolone-equivalent GCs.
This cohort underwent a GC taper at a rate of 1 mg/day and, of the 1850 patients, 742 experienced an overall flare, 271 experienced a severe flare, and 180 experienced damage accrual. The results showed there was no increased risk of overall or severe flare when reducing by 1 mg/day of prednisolone-equivalent GC dosage. Tapering these medications in this way also protected mSACQ patients, treated with >5 mg/day of prednisolone-equivalent GC, against damage accrual.
These findings suggest that cautious GC tapering is feasible and can reduce GC use in mSACQ patients, thus, reducing the likelihood of the negative effects of long-term GC use.
Katie Wright, EMJ
Reference
Katsumata Y et al. 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. Ann Rheum Dis. 2024;83(8):998-1005.
