Background/Purpose: Despite guidelines for SLE emphasizing the importance of tapering corticosteroids (CS), detailed recommendations on how to taper are limited. The purpose of this modified Delphi consensus exercise is to develop consensus-based guidance for tapering CS in patients with SLE, including specific tapering regimens.

Methods: Delphi RoundsFollowing a literature and guideline review, candidate statements were grouped into three topics: 1) CS-tapering regimens in lupus: general considerations2) Managing flares and patients with high risk of flare during CS tapering 3) Managing CS-associated toxicity and CS withdrawal symptomsOpen-ended and multiple-choice questions were also included, and example CS-tapering regimens for different disease severities were proposed. Results were obtained over two rounds of online surveys, with Round 1 results supporting the development of Round 2. In Round 2, respondents were asked to vote for which regimens they deemed acceptable for use in clinical practice and could vote for multiple regimens per patient scenario.Respondents Snowball sampling was used to identify a global interdisciplinary group of experts to participate in the Delphi rounds.Defining consensusIn Round 1, respondents were asked to rate their agreement with the candidate statements using a nine-point Likert scale, with a rating of 1–3 indicating disagreement, 4–6 indicating neutrality, and 7–9 indicating agreement. Consensus was defined as ≥70% of respondents voting either ≤3 (disagreement) or ≥7 (agreement). In Round 2, respondents were presented with the mean ratings from Round 1, their own Round 1 ratings, and the opportunity to revise their rating.

Results: Of the 124 respondents invited, 101 (81%) completed Round 1 and, of these, 94 (93%) completed Round 2. Respondents who completed both rounds were from 30 countries and comprised 79 rheumatologists, 11 nephrologists, three dermatologists, and one internist. Of the eight example CS-tapering regimens presented, three achieved ≥70% agreement that they would be acceptable to use in clinical practice (regimens for mild SLE, moderate SLE, and lupus nephritis or severe SLE). The regimens that received the highest agreement in Round 2 for each patient scenario are presented in Table 1. Consensus for either agreement or disagreement was achieved in 31/33 statements in Round 2 (Table 2).

Conclusion: This consensus-based guidance will support physicians in choosing a CS-tapering approach for patients with SLE across different clinical scenarios. The next step is to obtain the patient perspective on these results to ensure that patient preferences are considered when initiating CS tapering, followed by dissemination into routine practice.

Table 1: Summary of recommended CS-tapering regimens. *Respondents could choose multiple schemes that they considered acceptable; †CS-tapering regimen is the reduced-dose regimen from the KDIGO 2024 guidelines for lupus nephritis; ‡respondents voted that the regimen for active lupus nephritis could also be used in severe non-renal SLE as per Table 2. CS, corticosteroid; IV, intravenous; KDIGO, Kidney Disease: Improving Global Outcomes

Table 2: Consensus received on final CS-tapering voting statements. CS, corticosteroid; dsDNA, double-stranded DNA; IV, intravenous

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/guidance-for-corticosteroid-tapering-in-patients-with-systemic-lupus-erythematosus-results-from-an-international-delphi-consensus-project/