Rheumatology Unit, University of Campania "Luigi Vanvitelli", Caserta, Italy.
Lupus. 2021 May;30(6):991-997. doi: 10.1177/09612033211002269. Epub 2021 Mar 12.
A progressive tapering until withdrawal of glucocorticoids (GC) is considered one of the main goals of Systemic Lupus Erythematosus (SLE) management. However, which patient may be a candidate for safe GC withdrawal has not been determined yet. This study aimed to evaluate the rate of low-dose GC withdrawal in SLE patients in remission and to identify predictors of flares.
Eligible patients were SLE patients in prolonged clinical remission defined by a cSLEDAI = 0 for at least 2 years and on a stable SLE treatment (including daily 5 mg prednisone). Flares were defined by SELENA-SLEDAI Flare Index. Predictors of flares after GC withdrawal were analyzed by Cox regression.
We selected 56 patients in whom a GC withdrawal was attempted. 98 patients were in the prednisone maintenance group. The proportion of patients experiencing a flare was not significantly lower in the maintenance group than in the withdrawal group (p = 0.81). However, among the withdrawal group, the rate of flares was significantly higher in serologically active clinically quiescent (SACQ) patients (p < 0,0001). At Cox regression analysis, duration of hydroxychloroquine (HCQ) therapy and ≥5 year remission at withdrawal were protective factors, while a SACQ disease and history of lupus nephritis increased the risk of disease flare.
GC withdrawal is an achievable target in SLE and may be attempted in patients in complete remission.However, it might underline a caution in patients with SACQ disease who may be at greater risk forflare when GCare discontinued. HCQ therapy and durable remission can significantly reduce the risk.
糖皮质激素（GC）逐渐减量直至停药被认为是系统性红斑狼疮（SLE）管理的主要目标之一。然而，哪些患者可以安全停药尚未确定。本研究旨在评估缓解期 SLE 患者低剂量 GC 停药的比例，并确定复发的预测因素。
符合条件的患者为持续临床缓解至少 2 年且稳定 SLE 治疗（包括每天 5mg 泼尼松）的患者，cSLEDAI = 0。复发定义为 SELENA-SLEDAI 复发指数。采用 Cox 回归分析 GC 停药后复发的预测因素。
我们选择了 56 例尝试 GC 停药的患者。98 例患者在泼尼松维持组。维持组患者的复发率与停药组无显著差异（p = 0.81）。然而，在停药组中，血清学活动的临床静止（SACQ）患者的复发率显著更高（p < 0.0001）。Cox 回归分析显示，羟氯喹（HCQ）治疗持续时间和停药时≥5 年缓解是保护因素，而 SACQ 疾病和狼疮肾炎史增加了疾病复发的风险。
GC 停药是 SLE 可实现的目标，可尝试用于完全缓解的患者。然而，在 SACQ 疾病患者中可能需要谨慎，因为当 GC 停药时，这些患者可能面临更大的复发风险。HCQ 治疗和持久缓解可显著降低风险。
