RT Journal Article
SR Electronic
T1 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
JF Annals of the Rheumatic Diseases
JO Ann Rheum Dis
FD BMJ Publishing Group Ltd and European League Against Rheumatism
SP 998
OP 1005
DO 10.1136/ard-2023-225369
VO 83
IS 8
A1 Katsumata, Yasuhiro
A1 Inoue, Eisuke
A1 Harigai, Masayoshi
A1 Cho, Jiacai
A1 Louthrenoo, Worawit
A1 Hoi, Alberta
A1 Golder, Vera
A1 Lau, Chak Sing
A1 Lateef, Aisha
A1 Chen, Yi-Hsing
A1 Luo, Shue-Fen
A1 Wu, Yeong-Jian Jan
A1 Hamijoyo, Laniyati
A1 Li, Zhanguo
A1 Sockalingam, Sargunan
A1 Navarra, Sandra
A1 Zamora, Leonid
A1 Hao, Yanjie
A1 Zhang, Zhuoli
A1 Chan, Madelynn
A1 Oon, Shereen
A1 Ng, Kristine
A1 Kikuchi, Jun
A1 Takeuchi, Tsutomu
A1 Goldblatt, Fiona
A1 O’Neill, Sean
A1 Tugnet, Nicola
A1 Law, Annie Hui Nee
A1 Bae, Sang-Cheol
A1 Tanaka, Yoshiya
A1 Ohkubo, Naoaki
A1 Kumar, Sunil
A1 Kandane-Rathnayake, Rangi
A1 Nikpour, Mandana
A1 Morand, Eric F
A1 
YR 2024
UL http://ard.bmj.com/content/83/8/998.abstract
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.