Corticosteroids or Immunosuppressive Therapy Tapering Increases Flares in Stable SLE

Tapering of corticosteroids or immunosuppressive therapy increases systemic lupus erythematosus (SLE) flares in patients with stable disease, according to study results presented at the American College of Rheumatology (ACR) Convergence 2022, held from November 10 to 14, in Philadelphia, Pennsylvania.

Researchers conducted a prospective cohort study across 13 Asia-Pacific countries between 2013 and 2020. Patients diagnosed with SLE who had achieved lupus low disease activity state (LLDAS), clinical remission, or complete remission while receiving treatment with corticosteroids or immunosuppressive therapy were enrolled in the study.

Researchers used SLE Disease Activity Index 2000 (SLEDAI-2K) to measure disease activity levels at each visit; Safety of Estrogens in Lupus National Assessment (SELENA)-SLEDAI Flare Index to define flares; and the 2021 definitions of remission in SLE (DORIS) for clinical and complete remission (for both: SLEDAI, 0; Physician Global Assessment [PGA], <0.5; prednisolone, ≤5 mg/d).

Tapering was defined as a decrease in dose of corticosteroids or immunosuppressive therapy.

The researchers analyzed corticosteroids or immunosuppressive therapy tapering across 14,808 patient-visits among 3002 patients with SLE.

A total of 3521 (23.8%) visits included tapering of corticosteroids or immunosuppressive therapy and the remaining (n=11,287; 76.2%) included a continuation of the same therapy.

Overall, 2095 tapering attempts were recorded, which were initiated during LLDAS (41.1%), clinical remission (28.4%), and complete remission (30.5%).

A total of 1679 (12.8%) SLE flares were observed at subsequent visits, with a higher risk for flares among those who underwent drug tapering compared with those who continued receiving the same therapy (odds ratio, 1.24; P <.01). The SLE flares occurred a median of 238 days (range, 33-443 days) following tapering.

Compared with tapering attempts initiated during clinical remission or LLDAS, those initiated during complete remission resulted in longer time to first flare (hazard ratio, 0.79; P =.009).

Additional factors associated with longer time to flare included older age, shorter disease duration, geographic location, more than 30 days of remission or LLDAS prior to initiating the taper, and a lower adjusted mean score on the SLEDAI.

“Drug tapering should be carefully considered in stable patients [with SLE] irrespective [of] LLDAS or either type of remission,” the study authors said. “Attaining complete remission was more protective against flares upon drug tapering as compared to attaining LLDAS or clinical remission.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.