Gradual Glucocorticosteroid Withdrawal Safe and Associated With Fewer Flares, Less Damage Accrual in Quiescent SLE

Researchers assessed clinical flare rates and damage accrual among patients with systemic erythematosus lupus in whom glucocorticosteroids were gradually tapered.

In patients with clinically quiescent systemic lupus erythematosus (SLE), gradual glucocorticosteroid withdrawal is safe and is associated with fewer flares and less damage accrual at 24 months, according to study results published in ACR Open Rheumatology.

Researchers sought to evaluate clinical flare rates and damage accrual in patients with SLE in whom glucocorticoids were gradually tapered.

The current study was conducted among patients with 2 consecutive years of clinically quiescent SLE enrolled in the Toronto Lupus Clinic in Toronto, Canada. The 2 groups of participants were the maintenance group, including patients who were maintained a low prednisone dose (5 mg/d), and the withdrawal group, including patients who were gradually tapered off prednisone over the 24-month study period.

Index date was the end of the first prolonged clinical remission in the maintenance group and the withdrawal group. Study outcomes included the percentage of participants who experienced disease flares within the 2 years of follow-up, with flare rates assessed based on an increase in clinical SLE Disease Activity Index 2000 (SLEDAI-2K).

A total of 270 patients were eligible for the study, of whom 204 were matched (n=102 in each group). Results of the study showed that flare rates were significantly lower in the withdrawal group than in the maintenance group, at 12 months (17.6% vs 29.4%, respectively; P =.023) and at 24 months (33.3% vs 50.0%, respectively; P =.01).

Further, occurrence of moderate to severe flares, which required escalation of systemic therapy, did not differ significantly between the 2 groups at 12 months (10.8% vs 13.7%, respectively; P =.467), but occurred significantly less often at 24 months in the withdrawal vs maintenance group (14.7% vs 27.5%, respectively; P =.024). At 2 years, significantly more patients in the maintenance group than in the withdrawal group had new damage accrual (17.6% vs 6.9%, respectively; P =.022). No predictors for clinical flares were observed.

Study limitations included the observational design and the lack of standardization of the rate of glucocorticoid withdrawal.

Researchers concluded, “A randomized controlled trial could confirm whether gradual glucocorticoid tapering is preferable to abrupt withdrawal in such patients.”


Tselios K, Gladman DD, Su J, Urowitz MB. Gradual glucocorticosteroid withdrawal is safe in clinically quiescent systemic lupus erythematosus. ACR Open Rheumatol. Published online July 10, 2021. doi:10.1002/acr2.11267