Background/Purpose: Glucocorticoids (GC) are a cornerstone of the treatment of Systemic Lupus Erythematosus (SLE); however, a significant organ damage is associated with long-term GC use in SLE. GC withdrawal is therefore a target in SLE management.

The aims of our study were to evaluate the proportion of patients GC-free in a prospective cohort over a period of 6 years, to evaluate the main characteristics of patients at GC withdrawal with respect to the available definitions of remission and low disease activity (LDAS), to evaluate the occurrence of flares after GC withdrawal.

Methods: This is a retrospective study of prospectively collected data from a monocentric longitudinal cohort of patients with SLE (revised ACR criteria) followed from 2012 to 2017. Patients GC-free at last visit in 2017 were identified and compared with patients on GC at last visit. Patients GC free at the cohort entry (n= 35) or patients with incomplete follow-up (n=45) were excluded from this analysis. Disease activity was evaluated with the SELENA-SLEDAI index, while organ damage with the SLICC/DI. Definitions of remission according to the European consensus criteria (DORIS) and of LDAS according to the Asian Pacific Lupus Consortium definition and LDAS were applied at GC withdrawal.

Results: A total of 188 patients were included; characteristics of GC-free (n=69) and on GC patients ( n=119) at last observation are reported in table 1.

Among GC-free patients, disease activity at the moment of GC discontinuation was low (median SLEDAI: 1.2, IQR 0-2 ) and 12.2% of patients were serologically active; 77,8% had at least one organ damage. 49.2 % of patients were in complete remission on treatment (cRONT), 42.9% in clinical remission on treatment (clRONT) and 6.35% were in LLDAS.

Nine disease flares (14%) were recorded after GC withdrawal (6 cutaneous ± articular, 3 renal) after a median time of 1 year (min 6 months- max 3 years). By comparing the pre-GC stopping and the post GC stopping periods for each patients we didn’t observed a significant increase in the number of flares (p=n.s.); the patients who flared didn’t show a significant difference neither of SLEDAI, nor complement values at the stop of GC. Being in remission or in LDAS was not associated with a different risk in disease flare (OR:0.6; p=n.s)

Conclusion:

This analysis shows that GC withdrawal is feasible in a significant proportion of patients on remission or low disease activity; in these patients GC withdrawal is not associated with an increased risk of disease flare and probably it would spare damage accrual.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/glucocorticoids-withdrawal-in-systemic-lupus-erythematosus-are-remission-and-low-disease-activity-reliable-starting-points-for-stopping-therapy-a-real-life-experience/