Steroid-free remission in lupus: myth or reality; an observational study from a tertiary referral centre

Goswami, Rudra Prosad; Sit, Hiramanik; Ghosh, Parasar; Sircar, Geetabali; Ghosh, Alakendu

doi:10.1007/s10067-018-4377-7

Cited by 24 publications

(26 citation statements)

References 26 publications

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“…The 27% relapse rate observed in the withdrawal group in our study is in line with the ones recently reported in two recent cohorts 28 29. Tani et al described the longitudinal study of a cohort of 91 SLE Italian patients who attempted GC stopping 28.…”

Section: Discussionsupporting

confidence: 92%

“…Unlike our study, many flares were deemed major. Furthermore, Goswami et al defined duration of disease, duration of GCs before interruption and second immunosuppressive as independent predictors of flare-free survival,29 whereas in our prospective randomised study none of the above-mentioned factors was associated with the risk of flare after GC withdrawal. However, we cannot completely rule out certain associations since subgroups analyses were performed only on relatively small size samples.…”

Section: Discussioncontrasting

confidence: 68%

“…The time period since the last flare was the sole determinant predictor of disease flare identified 28. Goswami et al in a recent observational study preformed in India reported that 21% of patients in remission undergo exacerbation of the disease after GC withdrawal with most of the flares occurring in the first year of follow-up 29. Unlike our study, many flares were deemed major.…”

Section: Discussioncontrasting

confidence: 52%

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Withdrawal of low-dose prednisone in SLE patients with a clinically quiescent disease for more than 1 year: a randomised clinical trial

et al. 2019

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ObjectivesTo compare the efficacy to prevent flares of maintenance versus withdrawal of 5 mg/day prednisone in systemic lupus erythematosus (SLE) patients with clinically quiescent disease.MethodsA monocentric, 12-month, superiority, open-label, randomised (1:1) controlled trial was conducted with 61 patients continuing 5 mg/day prednisone and 63 stopping it. Eligibility criteria were SLE patients who, during the year preceding the inclusion, had a clinically inactive disease and a stable SLE treatment including 5 mg/day prednisone. The primary endpoint was the proportion of patient experiencing a flare defined with the SELENA-SLEDAI flare index (SFI) at 52 weeks. Secondary endpoints included time to flare, flare severity according to SFI and British Isles Lupus Assessment Group (BILAG) index and increase in the Systemic Lupus International Collaborating Clinics (SLICC) damage index (SDI).ResultsProportion of patients experiencing a flare was significantly lower in the maintenance group as compared with the withdrawal group (4 patients vs 17; RR 0.2 (95% CI 0.1 to 0.7), p=0.003). Maintenance of 5 mg prednisone was superior with respect to time to first flare (HR 0.2; 95% CI 0.1 to 0.6, p=0.002), occurrence of mild/moderate flares using the SFI (3 patients vs 12; RR 0.2 (95% CI 0.1 to 0.8), p=0.012) and occurrence of moderate/severe flares using the BILAG index (1 patient vs 8; RR 0.1 (95% CI 0.1 to 0.9), p=0.013). SDI increase and adverse events were similar in the two treatment groups. Subgroup analyses of the primary endpoint by predefined baseline characteristics did not show evidence of a different clinical response.ConclusionMaintenance of long term 5 mg prednisone in SLE patients with inactive disease prevents relapse.Trial registration numberNCT02558517; Results

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Section: Discussionsupporting

confidence: 92%

Section: Discussioncontrasting

confidence: 68%

Section: Discussioncontrasting

confidence: 52%

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Withdrawal of low-dose prednisone in SLE patients with a clinically quiescent disease for more than 1 year: a randomised clinical trial

et al. 2019

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“…Even if 72% of flares were mild, the reintroduction of GCs was necessary in almost all patients [11]. Similarly, Goswami et al reported that 21% of Indian patients in remission, and treated with HCQ, experienced an exacerbation of the disease after GC withdrawal [12]. Unlike the work of Tani et al, many flares were deemed major.…”

Section: Ability Of Low-dose Corticosteroids To Maintain Remission Inmentioning

confidence: 99%

Reducing lupus flares: should we be more careful about stopping glucocorticoids?

Mathian

Pha

Yssel

et al. 2020

Expert Review of Clinical Immunology

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“…A recent observational study, performed by Goswami et al in India, reported that 21% of patients in remission undergo exacerbation of the disease after GC withdrawal with most of the flares occurring in the first year of follow-up. 5 Therefore, until the availability of effective drugs with little or no toxicity, it is recommended to not abandon the option of using very low doses of GCs (i.e. £5 mg prednisone) given their potential benefits in SLE patients in remission, especially those at low cardiovascular risk.…”

mentioning

confidence: 99%

13 Can we withdraw low-dose prednisone in remitted patients?

Amoura

2020

Abstracts

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prednisone intake £7.5 mg, and negative predictors of remission and LDA were number of flares in the 3 years before belimumab treatment initiation and baseline renal involvement. Notably, patients spending at least 50% of follow-up in LDA (66%) or at least 25% of follow-up in remission (42.9%) accumulated less damage at the end of the follow-up. Consequently, this study provided novel evidence that an earlier use of belimumab in patients with active SLE and low damage may maximise its efficacy in clinical practice. Learning Objectives. Explain the importance of achieving remission or LDA in SLE management. Describe the role of belimumab in achieving remission or LDA in post-hoc analysis of the randomised control trials. Discuss the best use of belimumab in clinical practice settings

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Steroid-free remission in lupus: myth or reality; an observational study from a tertiary referral centre

Cited by 24 publications

References 26 publications

Withdrawal of low-dose prednisone in SLE patients with a clinically quiescent disease for more than 1 year: a randomised clinical trial

Withdrawal of low-dose prednisone in SLE patients with a clinically quiescent disease for more than 1 year: a randomised clinical trial

Reducing lupus flares: should we be more careful about stopping glucocorticoids?

13 Can we withdraw low-dose prednisone in remitted patients?

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