ArticleRMD open2025
Predictors of a successful glucocorticoid tapering and withdrawal in an inception cohort of patients with lupus nephritis and associations with long-term outcomes and damage accrual.
Article in RMD open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.
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Who cites it
3 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The 2026 British Society for Rheumatology guideline for the management of children, young people and adults with systemic lupus erythematosus.Rheumatology (Oxford, England) · 2026Guideline
- Tapering strategies for immunosuppressive, corticosteroid, and biologic therapy in lupus nephritis: a national survey of rheumatology and nephrology practices in Saudi Arabia.Rheumatology international · 2026Article
- Predictors and long-term impact of sustained complete renal response in lupus nephritis patients over a median 10-year follow-up.Rheumatology (Oxford, England) · 2026Article
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThe optimal duration of glucocorticoid (GC) treatment in lupus nephritis (LN) remains unclear. We examined predictors of GC tapering and discontinuation (D/C), flares during tapering and post-D/C and long-term outcomes.
methodsWe analysed inception cohort data (1992-2021) from 136 patients with LN (median follow-up: 121 months) and applied regression models to assess predictors of successful GC D/C and long-term outcomes, including clinical/laboratory, histological and treatment characteristics.
resultsMedian time to 7.5 mg/day, 5 mg/day and GC D/C was 9, 12 and 29 months post-diagnosis, respectively. Composite complete renal response (CR) and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)-2K≤4, sustainedly attained until GC D/C (HR: 1.85, p=0.016), membranous LN (HR: 1.81, p=0.01) and persistent use of hydroxychloroquine (HR: 1.49, p=0.04) were associated with a shorter time to GC D/C. Patients diagnosed after 2010 achieved earlier GC D/C.Shorter time to CR (OR: 1.05, p=0.034) and Lupus Low Disease Activity State at tapering from 7.5 mg/day onwards (OR: 0.23, p=0.046) reduced flare risk during tapering. Definition Of Remission In Systemic Lupus Erythematosus (DORIS) complete remission at D/C (OR: 0.20, p=0.005) and persistent hydroxychloroquine use (OR: 0.28, p=0.031) protected against post-D/C renal flares. Neither higher initial GC dose (>40 mg/day) nor slower GC tapering prevented renal flares. Time to GC D/C (OR: 1.02/month, p=0.04) and flares (OR: 2.08, p=0.036) were associated with damage risk at the end of follow-up.
conclusionSustained CR/SLEDAI-2K≤4, membranous LN and persistent hydroxychloroquine use emerged as main predictors of shorter time to D/C, while DORIS complete remission at D/C and persistent hydroxychloroquine use predicted post-DC flares. Time to GC D/C and flares independently contributed to 10-year damage accrual.
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