Huang Sicheng, Jia Yimeng, Zhang Yuelun, Chen Hongda, Deng Chuiwen, Fei Yunyun
Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), State Key Laboratory of Complex Severe and Rare Diseases, The Ministry of Education Key Laboratory, Beijing 100730, China.
Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
iScience. 2025 Jun 13;28(7):112875. doi: 10.1016/j.isci.2025.112875. eCollection 2025 Jul 18.
Whether discontinuing glucocorticoids (GCs) increases relapse risk in systemic lupus erythematosus (SLE) remains a critical consideration. A systematic review and meta-analysis of 10 randomized clinical trials (RCTs) and observational cohort studies was conducted to evaluate relapse outcomes after GC withdrawal versus maintenance. RCTs showed that GC withdrawal led to a higher overall relapse rate (risk difference [RD] 0.13; 95% CI 0.03-0.23; = 0.008) and an increased rate of severe relapses (RD 0.02; 95% CI 0.00-0.05; = 0.04), whereas observational cohorts found similar relapse rates between withdrawal and maintenance and demonstrated non-inferiority within a 15% margin. These findings indicate that GC withdrawal should be approached with caution in patients with SLE, and more research is needed to identify which patients can safely discontinue GC. This review should help guide the choice of maintenance therapy and highlights the need for personalized tapering strategies to optimize long-term outcomes in SLE management.
停用糖皮质激素（GCs）是否会增加系统性红斑狼疮（SLE）的复发风险仍是一个关键考量因素。我们对10项随机临床试验（RCTs）和观察性队列研究进行了系统评价和荟萃分析，以评估GC撤药与维持治疗后的复发结局。RCTs显示，GC撤药导致总体复发率更高（风险差[RD] 0.13；95%置信区间[CI] 0.03 - 0.23；P = 0.008），严重复发率增加（RD 0.02；95% CI 0.00 - 0.05；P = 0.04），而观察性队列研究发现撤药组和维持治疗组的复发率相似，且在15%的界值内显示出非劣效性。这些发现表明，对于SLE患者，GC撤药应谨慎进行，需要更多研究来确定哪些患者可以安全停用GC。本综述应有助于指导维持治疗的选择，并强调需要个性化的减量策略，以优化SLE管理的长期结局。
