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

Katsumata Y 1 , Inoue E 2 , Harigai M 2 , Cho J 3 , Louthrenoo W 4 , Hoi A 5 Show all authors , Golder V 5 , Lau CS 6 , Lateef A 7 , Chen YH 8 , Luo SF 9 , Wu YJ 10 , Hamijoyo L 11 , Li Z 12 , Sockalingam S 13 , Navarra S 14 , Zamora L 15 , Hao Y 16 , Zhang Z 17 , Chan M 18 , Oon S 19 , Ng K 20 , Kikuchi J 21 , Takeuchi T 21 , Goldblatt F 22 , O'Neill S 23 , Tugnet N 24 , Law AHN 25 , Bae SC 26 , Tanaka Y 27 , Ohkubo N 27 , Kumar S 28 , Kandane-Rathnayake R 5 , Nikpour M 29 , Morand EF 5 , Asia-Pacific Lupus Collaboration

Affiliations 

  • 1 Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan [email protected]
  • 2 Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
  • 3 National University Hospital of Singapore, Singapore
  • 4 Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  • 5 School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
  • 6 The University of Hong Kong, Hong Kong, Hong Kong
  • 7 National University Health System, Singapore
  • 8 Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
  • 9 Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital, Kuei Shan, Taiwan
  • 10 Department of Medicine, Division of Allergy, Immunology and Rheumatology, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
  • 11 Rheumatology Division, Internal Medicine, Padjadjaran University, Bandung, Indonesia
  • 12 People's Hospital Peking University Health Sciences Centre, Beijing, China
  • 13 Faculty of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
  • 14 University of Santo Tomas Hospital, Manila, The Philippines
  • 15 Faculty of Medicine and Surgery, University of Santo Tomas, Manila, The Philippines
  • 16 University of Melbourne at St Vincent's Hospital, Fitzroy, Victoria, Australia
  • 17 Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
  • 18 Tan Tock Seng Hospital, Singapore
  • 19 Department of Medicine, The University of Melbourne at St Vincent's Hospital, Fitzroy, Victoria, Australia
  • 20 Waitemata District Health Board, Auckland, New Zealand
  • 21 Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
  • 22 Repatriation General Hospital, Daw Park, South Australia, Australia
  • 23 University of New South Wales, Sydney, New South Wales, Australia
  • 24 Auckland District Health Board, Auckland, New Zealand
  • 25 Rheumatology and Immunology, Singapore General Hospital, Singapore
  • 26 Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea (the Republic of)
  • 27 First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
  • 28 Middlemore Hospital, Auckland, New Zealand
  • 29 Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia
Ann Rheum Dis, 2024 Jul 15;83(8):998-1005.
PMID: 38423757 DOI: 10.1136/ard-2023-225369

Abstract

OBJECTIVES: To assess the risk of flare and damage accrual after tapering glucocorticoids (GCs) in modified serologically active clinically quiescent (mSACQ) patients with systemic lupus erythematosus (SLE).

METHODS: Data from a 12-country longitudinal SLE cohort, collected prospectively between 2013 and 2020, were analysed. SLE patients with mSACQ defined as the state with serological activity (increased anti-dsDNA and/or hypocomplementemia) but without clinical activity, treated with ≤7.5 mg/day of prednisolone-equivalent GCs and not-considering duration, were studied. The risk of subsequent flare or damage accrual per 1 mg decrease of prednisolone was assessed using Cox proportional hazard models while adjusting for confounders. Observation periods were 2 years and censored if each event occurred.

RESULTS: Data from 1850 mSACQ patients were analysed: 742, 271 and 180 patients experienced overall flare, severe flare and damage accrual, respectively. Tapering GCs by 1 mg/day of prednisolone was not associated with increased risk of overall or severe flare: adjusted HRs 1.02 (95% CI, 0.99 to 1.05) and 0.98 (95% CI, 0.96 to 1.004), respectively. Antimalarial use was associated with decreased flare risk. Tapering GCs was associated with decreased risk of damage accrual (adjusted HR 0.96, 95% CI, 0.93 to 0.99) in the patients whose initial prednisolone dosages were >5 mg/day.

CONCLUSIONS: In mSACQ patients, tapering GCs was not associated with increased flare risk. Antimalarial use was associated with decreased flare risk. Tapering GCs protected mSACQ patients treated with >5 mg/day of prednisolone against damage accrual. These findings suggest that cautious GC tapering is feasible and can reduce GC use in mSACQ patients.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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