Glucocorticoid Discontinuation in Patients With Systemic Lupus Erythematosus With Prior Severe Organ Involvement: a Single-center Retrospective Analysis

Abstract Background:Long-term glucocorticoid use in systemic lupus erythematosus (SLE) may have significant side effects; however, glucocorticoid discontinuation is occasionally associated with disease flare-ups. Therefore, we evaluated the risk factors for disease flares and the flare rate upon glucocorticoid tapering in patients with prior severe organ involvement.Methods:Patients with SLE with glucocorticoid tapering at our institution were retrospectively analyzed. We divided the patients according to the presence of prior severe organ involvement and compared flare rates and time to first flare after glucocorticoid discontinuation. Furthermore, we determined risk and protective factors for flares after glucocorticoid discontinuation.Results:A total of 309 patients with SLE were screened; 298 had prednisolone tapered to less than 7.5 mg/day and 75 had glucocorticoid discontinuation. Overall, 73 patients met the inclusion criteria; 49 were classified as SLE with prior severe organ involvement. No statistical differences were noted in the 52-week flare rate and time to first flare after glucocorticoid discontinuation between patients with and without prior severe organ involvement (52-week flare rate: 16.7% vs. 18.2%, p = 1.0; time to first flare: 322 [280, 1169] vs. 385 [304, 2345] days, p = 0.33). Hypocomplementemia, elevated anti-dsDNA antibody titers of more than twice the upper limit of the laboratory reference range, and positive anti-Smith/anti-ribonucleoprotein antibody were negatively associated with flare-free remission.Conclusion:Glucocorticoid discontinuation can often be achieved in patients with SLE without increasing flare risk in most patients with prior severe organ involvement, especially when the disease is clinically and serologically stable.