Effects of glucocorticoid withdrawal on relapse risk in systemic lupus erythematosus: A systematic review and meta-analysis.

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.