medwireNews: Glucocorticoid tapering and complete withdrawal can be achieved in patients with systemic lupus erythematosus (SLE) and may be particularly successful in those with long-term remission or low disease activity, Italian researchers report.
Marta Mosca (University of Pisa) and colleagues say that “[d]isease flares are not common in this subset of patients,” but they caution that when they do occur it can be at any time “thus, close disease monitoring after [glucocorticoid] withdrawal is necessary.”
During the course of the 6-year study, 61.5% of 148 people with SLE (mean age 42 years; mean disease duration 14 years) attempted glucocorticoid withdrawal, at which point the median daily dose being used was 5 mg/prednisone equivalent per day.
Of these, 84.6% achieved withdrawal, defined as completely stopping glucocorticoids without a flare during tapering, after a median of 11 months.
The majority (97.0%) of the patients who attempted withdrawal were in Lupus Low Disease Activity State (LLDAS), with 48.9% in complete remission and 39.6% in clinical remission.
As reported in RMD Open, patients who successfully stopped glucocorticoids had significantly lower disease activity when the physician decided to begin tapering than those who failed in their attempt (mean SLEDAI 1.31 vs 2.57 points).
The time since the last flare was also longer among the patients who successfully stopped glucocorticoid therapy versus those who did not (5.21 vs 4.57 years), but not significantly so.
Just under a quarter (23%) of patients who successfully withdrew glucocorticoid therapy experienced a flare during a median 2 years of follow-up, with the majority (94%) needing to restart treatment.
Patients who experienced flare after withdrawal were more likely to have had an SLEDAI above 4 at baseline (16.6 vs 1.0%) as well as a shorter time since their last flare (median 1.5 vs 5.0 years).
However, on multivariate analysis none of the variables examined predicted the likelihood for either successful withdrawal or the risk for a flare following withdrawal.
Mosca and co-authors say it is interesting that “the state of being in clinical remission, in complete remission or in LLDAS at the time of the physician’s decision to stop [glucocorticoids] does not constitute a different risk in terms of disease flare.”
They add: “[T]his is a crucial point demonstrating that all such conditions might be similarly considered a valid starting point for treatment tapering and withdrawal.”
In conclusion, the researchers “hope that these data might be useful to treating physicians as an initial input on when the right moment could be to attempt [glucocorticoid] withdrawal.”
By Laura Cowen
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