PT  - JOURNAL ARTICLE
AU  - Katsumata, Yasuhiro
AU  - Inoue, Eisuke
AU  - Harigai, Masayoshi
AU  - Cho, Jiacai
AU  - Louthrenoo, Worawit
AU  - Hoi, Alberta
AU  - Golder, Vera
AU  - Lau, Chak Sing
AU  - Lateef, Aisha
AU  - Chen, Yi-Hsing
AU  - Luo, Shue-Fen
AU  - Wu, Yeong-Jian Jan
AU  - Hamijoyo, Laniyati
AU  - Li, Zhanguo
AU  - Sockalingam, Sargunan
AU  - Navarra, Sandra
AU  - Zamora, Leonid
AU  - Hao, Yanjie
AU  - Zhang, Zhuoli
AU  - Chan, Madelynn
AU  - Oon, Shereen
AU  - Ng, Kristine
AU  - Kikuchi, Jun
AU  - Takeuchi, Tsutomu
AU  - Goldblatt, Fiona
AU  - O’Neill, Sean
AU  - Tugnet, Nicola
AU  - Law, Annie Hui Nee
AU  - Bae, Sang-Cheol
AU  - Tanaka, Yoshiya
AU  - Ohkubo, Naoaki
AU  - Kumar, Sunil
AU  - Kandane-Rathnayake, Rangi
AU  - Nikpour, Mandana
AU  - Morand, Eric F
ED  - ,
TI  - Risk of flare and damage accrual after tapering glucocorticoids in modified serologically active clinically quiescent patients with systemic lupus erythematosus: a multinational observational cohort study
AID  - 10.1136/ard-2023-225369
DP  - 2024 Aug 01
TA  - Annals of the Rheumatic Diseases
PG  - 998--1005
VI  - 83
IP  - 8
4099  - http://ard.bmj.com/content/83/8/998.short
4100  - http://ard.bmj.com/content/83/8/998.full
SO  - Ann Rheum Dis2024 Aug 01; 83
AB  - Objectives To assess the risk of flare and damage accrual after tapering glucocorticoids (GCs) in modified serologically active clinically quiescent (mSACQ) patients with systemic lupus erythematosus (SLE).Methods Data from a 12-country longitudinal SLE cohort, collected prospectively between 2013 and 2020, were analysed. SLE patients with mSACQ defined as the state with serological activity (increased anti-dsDNA and/or hypocomplementemia) but without clinical activity, treated with ≤7.5 mg/day of prednisolone-equivalent GCs and not-considering duration, were studied. The risk of subsequent flare or damage accrual per 1 mg decrease of prednisolone was assessed using Cox proportional hazard models while adjusting for confounders. Observation periods were 2 years and censored if each event occurred.Results Data from 1850 mSACQ patients were analysed: 742, 271 and 180 patients experienced overall flare, severe flare and damage accrual, respectively. Tapering GCs by 1 mg/day of prednisolone was not associated with increased risk of overall or severe flare: adjusted HRs 1.02 (95% CI, 0.99 to 1.05) and 0.98 (95% CI, 0.96 to 1.004), respectively. Antimalarial use was associated with decreased flare risk. Tapering GCs was associated with decreased risk of damage accrual (adjusted HR 0.96, 95% CI, 0.93 to 0.99) in the patients whose initial prednisolone dosages were >5 mg/day.Conclusions In mSACQ patients, tapering GCs was not associated with increased flare risk. Antimalarial use was associated with decreased flare risk. Tapering GCs protected mSACQ patients treated with >5 mg/day of prednisolone against damage accrual. These findings suggest that cautious GC tapering is feasible and can reduce GC use in mSACQ patients.Data are available upon reasonable request.