Glucocorticoids are a mainstay of treatment for systemic lupus erythematosus (SLE). But due to long-term adverse effects, dose reduction is becoming a crucial part of treat-to-target management goals. However, data regarding the optimum dose target are conflicting.
Recommendations from EULAR - The European Alliance of Associations for Rheumatology - advise a glucocorticoid dose of no more than 5 mg/day. However, the threshold in the validated lupus low disease activity state (LLDAS) definition is no more than 7.5 mg/day.
It is also still unclear whether it is safe and feasible to withdraw glucocorticoids after achieving remission. In a session on diagnosing and managing complex diseases at the 2024 EULAR congress in Vienna, two abstracts tackled this issue. First, Filippo Vesentini presented on the risk of flare with glucocorticoid compared to low-dose maintenance - based on a retrospective analysis of prospectively collected data from people with SLE.
Flare-free remission and predictors of such were evaluated respectively in remitted patients on and off glucocorticoids. During follow-up, 484 patients achieved remission at least once during follow-up - 360 patients of these discontinued glucocorticoids, while 124 remained on a dose of 5 mg per day or less. There were subsequently 85 flares over a mean period of 87 months.
Of these, 48 were in those who had discontinued glucocorticoids, and 37 in those remaining on a low dose - equivalent to an annual flare rate of 8.5 and 1.6.
