Combining remission, hydroxychloroquine use, and a slow glucocorticoid tapering process reduced severe lupus flare risks by up to 50-fold, according to a recent study.

Researchers published a retrospective cohort study evaluating clinical predictors for successful glucocorticoid (GC) withdrawal in systemic lupus erythematosus (SLE). The study, published in RMD Open, analyzed data from 324 patients with moderate-to-severe SLE activity, defined by a SLEDAI-2K score of 6 or more or a Physician Global Assessment score of 1.5 or more, who underwent GC therapy initiation or intensification. Patients were monitored over a median follow-up of 60 months to assess flare risks and factors influencing outcomes.

Of the cohort, 67.9% (220 patients) discontinued GC use, with 71.4% experiencing at least one flare and 40% having a severe flare following withdrawal. The incidence rates were 5.4 per 10 patient-years for overall flares and 1.8 per 10 patient-years for severe flares. Patients who discontinued GCs had a significantly higher risk of overall flares (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.12–1.96) and severe flares (HR, 1.52; 95% CI, 1.03–2.25) compared to those who continued GC therapy.

Key protective factors included achieving remission (DORIS criteria) or Lupus Low Disease Activity State (LLDAS) at the time of GC withdrawal. Patients in remission demonstrated a 77% reduction in severe flare risk (HR, 0.23; 95% CI, 0.12–0.43), while those achieving LLDAS saw a 70% reduction (HR, 0.30; 95% CI, 0.18–0.50). Each additional month in DORIS or LLDAS further reduced the risk of flares (HR per month: 0.96; 95% CI, 0.94–0.97).

Hydroxychloroquine use was another significant predictor, lowering the risk of overall (HR, 0.37; 95% CI, 0.26–0.53) and severe flares (HR, 0.33; 95% CI, 0.21–0.52). Gradual GC tapering, specifically over a period longer than six months from 7.5 mg/day to discontinuation, reduced severe flare risks by 43% (HR, 0.57; 95% CI, 0.37–0.90). Combining these protective factors decreased overall flare risk by approximately 25-fold and severe flare risk by 50-fold compared to patients without these measures.

Full disclosures can be found in the published study.