Glucocorticoid withdrawal in systemic lupus erythematosus: are remission and low disease activity reliable starting points for stopping treatment? A real-life experience.
glucocorticoids
low disease activity state
remission
Journal
RMD open
ISSN: 2056-5933
Titre abrégé: RMD Open
Pays: England
ID NLM: 101662038
Informations de publication
Date de publication:
2019
2019
Historique:
received:
04
02
2019
revised:
02
04
2019
accepted:
09
05
2019
entrez:
6
7
2019
pubmed:
6
7
2019
medline:
6
7
2019
Statut:
epublish
Résumé
To evaluate the proportion of patients who have successfully withdrawn glucocorticoids (GCs) in a longitudinal cohort of patients with systemic lupus erythematosus (SLE) over a period of 6 years; to evaluate patient characteristics during GC withdrawal in relation to existing definitions of remission and Lupus Low Disease Activity State (LLDAS); and to evaluate the occurrence of flares after GC withdrawal. Patients who attempted GC withdrawal were identified for the cohort, and the following information was assessed during withdrawal attempts: date of last disease flare, disease activity and damage and ongoing treatment. Information regarding the occurrence of disease flares after GC withdrawal was also recorded for patients who successfully stopped treatment.Definitions of remission were applied to GC withdrawal in line with European consensus criteria (Definitions of remission in SLE [DORIS]) and LLDAS in line with the Asian Pacific Lupus Consortium definition. 148 patients were involved in the study; GC withdrawal was attempted in 91 patients (61.5%) with 77 patients (84.6%) successfully stopping GCs. At the beginning of the GC reduction, the majority of patients were in complete or clinical remission (48.9% and 39.6%, respectively). Disease activity was significantly lower in patients who successfully stopped GCs, and the proportion of patients in complete remission was higher (54.2%) with respect to patients who failed in their attempt. Among patients who stopped GCs, 18 flares were recorded after a median of 1 year. The time period since the last flare was shorter in patients who experienced flares with respect to patients who did not flare (mean 0.93 years vs 6.0, p<0.001). GC withdrawal is an achievable goal in SLE and may be attempted after a long-term remission or LLDAS to protect the patient from disease flares.
Identifiants
pubmed: 31275608
doi: 10.1136/rmdopen-2019-000916
pii: rmdopen-2019-000916
pmc: PMC6579574
doi:
Substances chimiques
Glucocorticoids
0
Types de publication
Comparative Study
Journal Article
Langues
eng
Pagination
e000916Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Lupus. 2013 Jun;22(7):697-701
pubmed: 23708944
Arthritis Care Res (Hoboken). 2018 Apr;70(4):582-591
pubmed: 28704598
Arthritis Care Res (Hoboken). 2019 Jun;71(6):822-828
pubmed: 30055090
Ann Rheum Dis. 2017 Mar;76(3):562-565
pubmed: 27884821
Clin Exp Rheumatol. 2013 Jul-Aug;31(4 Suppl 78):S75-81
pubmed: 24129143
Ann Rheum Dis. 2015 Dec;74(12):2117-22
pubmed: 26223434
Clin Exp Rheumatol. 2011 Sep-Oct;29(5 Suppl 68):S126-9
pubmed: 22018198
Rheumatology (Oxford). 1999 Aug;38(8):724-7
pubmed: 10501419
J Rheumatol. 2003 Sep;30(9):1955-9
pubmed: 12966597
Medicine (Baltimore). 1996 Mar;75(2):88-98
pubmed: 8606630
Ann Rheum Dis. 2016 Sep;75(9):1615-21
pubmed: 26458737
Rheumatology (Oxford). 2018 Apr 1;57(4):677-687
pubmed: 29361147
Ann Rheum Dis. 2017 Aug;76(8):1420-1425
pubmed: 28432050
Ann Rheum Dis. 2018 Jan;77(1):104-110
pubmed: 28970217
Arthritis Rheumatol. 2018 Nov;70(11):1790-1795
pubmed: 29806142
Medicine (Baltimore). 2004 Jan;83(1):1-17
pubmed: 14747764
Am J Med. 1988 Aug;85(2):275
pubmed: 3400709
Osteoporos Int. 2002 Oct;13(10):777-87
pubmed: 12378366
Autoimmun Rev. 2018 Jan;17(1):11-18
pubmed: 29108824
Ann Rheum Dis. 2014 Jun;73(6):958-67
pubmed: 24739325
J Rheumatol. 2014 Sep;41(9):1808-16
pubmed: 25086082
J Rheumatol. 2018 Oct;45(10):1440-1447
pubmed: 30068762
Ann Rheum Dis. 2017 Mar;76(3):554-561
pubmed: 27884822
Rheumatol Int. 2015 Apr;35(4):701-8
pubmed: 25257763
Ann Rheum Dis. 2012 Nov;71(11):1771-82
pubmed: 22851469
Arthritis Res Ther. 2017 Mar 20;19(1):62
pubmed: 28320433
Arthritis Rheum. 2000 Aug;43(8):1801-8
pubmed: 10943870
Arch Med Res. 1998 Autumn;29(3):259-62
pubmed: 9775461
Lupus Sci Med. 2017 Jun 29;4(1):e000173
pubmed: 29238601
Clin Exp Rheumatol. 2013 Jul-Aug;31(4 Suppl 78):S71-4
pubmed: 24129142
Nephrol Dial Transplant. 2006 Jun;21(6):1541-8
pubmed: 16455674
Rheumatology (Oxford). 2005 Dec;44(12):1492-502
pubmed: 16234277
Ann Rheum Dis. 2012 Jul;71(7):1128-33
pubmed: 22241902
Rheumatology (Oxford). 2017 Jan;56(1):121-128
pubmed: 27803306
J Rheumatol. 2005 Aug;32(8):1467-72
pubmed: 16078321
Rheumatol Int. 2013 Aug;33(8):1923-32
pubmed: 23588411