Yasuhiro Katsumata, Eisuke Inoue, Masayoshi Harigai, Jiacai Cho, Worawit Louthrenoo, Alberta Hoi, Vera Golder, Chak Sing Lau, Aisha Lateef, Yi-Hsing Chen, Shue-Fen Luo, Yeong-Jian Jan Wu, Laniyati Hamijoyo, Zhanguo Li, Sargunan Sockalingam, Sandra Navarra, Leonid Zamora, Yanjie Hao, Zhuoli Zhang, Madelynn Chan, Shereen Oon, Kristine Ng, Jun Kikuchi, Tsutomu Takeuchi, Fiona Goldblatt, Sean O'Neill, Nicola Tugnet, Annie Hui Nee Law, Sang-Cheol Bae, Yoshiya Tanaka, Naoaki Ohkubo, Sunil Kumar, Rangi Kandane-Rathnayake, Mandana Nikpour, Eric F Morand
{"title":"系统性红斑狼疮血清学活跃临床静止期改良患者减量糖皮质激素后复发和损害累积的风险:一项多国观察队列研究。","authors":"Yasuhiro Katsumata, Eisuke Inoue, Masayoshi Harigai, Jiacai Cho, Worawit Louthrenoo, Alberta Hoi, Vera Golder, Chak Sing Lau, Aisha Lateef, Yi-Hsing Chen, Shue-Fen Luo, Yeong-Jian Jan Wu, Laniyati Hamijoyo, Zhanguo Li, Sargunan Sockalingam, Sandra Navarra, Leonid Zamora, Yanjie Hao, Zhuoli Zhang, Madelynn Chan, Shereen Oon, Kristine Ng, Jun Kikuchi, Tsutomu Takeuchi, Fiona Goldblatt, Sean O'Neill, Nicola Tugnet, Annie Hui Nee Law, Sang-Cheol Bae, Yoshiya Tanaka, Naoaki Ohkubo, Sunil Kumar, Rangi Kandane-Rathnayake, Mandana Nikpour, Eric F Morand","doi":"10.1136/ard-2023-225369","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To assess the risk of flare and damage accrual after tapering glucocorticoids (GCs) in modified serologically active clinically quiescent (mSACQ) patients with systemic lupus erythematosus (SLE).</p><p><strong>Methods: </strong>Data from a 12-country longitudinal SLE cohort, collected prospectively between 2013 and 2020, were analysed. SLE patients with mSACQ defined as the state with serological activity (increased anti-dsDNA and/or hypocomplementemia) but without clinical activity, treated with ≤7.5 mg/day of prednisolone-equivalent GCs and not-considering duration, were studied. The risk of subsequent flare or damage accrual per 1 mg decrease of prednisolone was assessed using Cox proportional hazard models while adjusting for confounders. Observation periods were 2 years and censored if each event occurred.</p><p><strong>Results: </strong>Data from 1850 mSACQ patients were analysed: 742, 271 and 180 patients experienced overall flare, severe flare and damage accrual, respectively. Tapering GCs by 1 mg/day of prednisolone was not associated with increased risk of overall or severe flare: adjusted HRs 1.02 (95% CI, 0.99 to 1.05) and 0.98 (95% CI, 0.96 to 1.004), respectively. Antimalarial use was associated with decreased flare risk. Tapering GCs was associated with decreased risk of damage accrual (adjusted HR 0.96, 95% CI, 0.93 to 0.99) in the patients whose initial prednisolone dosages were >5 mg/day.</p><p><strong>Conclusions: </strong>In mSACQ patients, tapering GCs was not associated with increased flare risk. Antimalarial use was associated with decreased flare risk. Tapering GCs protected mSACQ patients treated with >5 mg/day of prednisolone against damage accrual. These findings suggest that cautious GC tapering is feasible and can reduce GC use in mSACQ patients.</p>","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":null,"pages":null},"PeriodicalIF":20.3000,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Risk of flare and damage accrual after tapering glucocorticoids in modified serologically active clinically quiescent patients with systemic lupus erythematosus: a multinational observational cohort study.\",\"authors\":\"Yasuhiro Katsumata, Eisuke Inoue, Masayoshi Harigai, Jiacai Cho, Worawit Louthrenoo, Alberta Hoi, Vera Golder, Chak Sing Lau, Aisha Lateef, Yi-Hsing Chen, Shue-Fen Luo, Yeong-Jian Jan Wu, Laniyati Hamijoyo, Zhanguo Li, Sargunan Sockalingam, Sandra Navarra, Leonid Zamora, Yanjie Hao, Zhuoli Zhang, Madelynn Chan, Shereen Oon, Kristine Ng, Jun Kikuchi, Tsutomu Takeuchi, Fiona Goldblatt, Sean O'Neill, Nicola Tugnet, Annie Hui Nee Law, Sang-Cheol Bae, Yoshiya Tanaka, Naoaki Ohkubo, Sunil Kumar, Rangi Kandane-Rathnayake, Mandana Nikpour, Eric F Morand\",\"doi\":\"10.1136/ard-2023-225369\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To assess the risk of flare and damage accrual after tapering glucocorticoids (GCs) in modified serologically active clinically quiescent (mSACQ) patients with systemic lupus erythematosus (SLE).</p><p><strong>Methods: </strong>Data from a 12-country longitudinal SLE cohort, collected prospectively between 2013 and 2020, were analysed. SLE patients with mSACQ defined as the state with serological activity (increased anti-dsDNA and/or hypocomplementemia) but without clinical activity, treated with ≤7.5 mg/day of prednisolone-equivalent GCs and not-considering duration, were studied. The risk of subsequent flare or damage accrual per 1 mg decrease of prednisolone was assessed using Cox proportional hazard models while adjusting for confounders. Observation periods were 2 years and censored if each event occurred.</p><p><strong>Results: </strong>Data from 1850 mSACQ patients were analysed: 742, 271 and 180 patients experienced overall flare, severe flare and damage accrual, respectively. Tapering GCs by 1 mg/day of prednisolone was not associated with increased risk of overall or severe flare: adjusted HRs 1.02 (95% CI, 0.99 to 1.05) and 0.98 (95% CI, 0.96 to 1.004), respectively. Antimalarial use was associated with decreased flare risk. Tapering GCs was associated with decreased risk of damage accrual (adjusted HR 0.96, 95% CI, 0.93 to 0.99) in the patients whose initial prednisolone dosages were >5 mg/day.</p><p><strong>Conclusions: </strong>In mSACQ patients, tapering GCs was not associated with increased flare risk. Antimalarial use was associated with decreased flare risk. Tapering GCs protected mSACQ patients treated with >5 mg/day of prednisolone against damage accrual. These findings suggest that cautious GC tapering is feasible and can reduce GC use in mSACQ patients.</p>\",\"PeriodicalId\":8087,\"journal\":{\"name\":\"Annals of the Rheumatic Diseases\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":20.3000,\"publicationDate\":\"2024-07-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of the Rheumatic Diseases\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1136/ard-2023-225369\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"RHEUMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of the Rheumatic Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/ard-2023-225369","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RHEUMATOLOGY","Score":null,"Total":0}
Risk of flare and damage accrual after tapering glucocorticoids in modified serologically active clinically quiescent patients with systemic lupus erythematosus: a multinational observational cohort study.
Objectives: To assess the risk of flare and damage accrual after tapering glucocorticoids (GCs) in modified serologically active clinically quiescent (mSACQ) patients with systemic lupus erythematosus (SLE).
Methods: Data from a 12-country longitudinal SLE cohort, collected prospectively between 2013 and 2020, were analysed. SLE patients with mSACQ defined as the state with serological activity (increased anti-dsDNA and/or hypocomplementemia) but without clinical activity, treated with ≤7.5 mg/day of prednisolone-equivalent GCs and not-considering duration, were studied. The risk of subsequent flare or damage accrual per 1 mg decrease of prednisolone was assessed using Cox proportional hazard models while adjusting for confounders. Observation periods were 2 years and censored if each event occurred.
Results: Data from 1850 mSACQ patients were analysed: 742, 271 and 180 patients experienced overall flare, severe flare and damage accrual, respectively. Tapering GCs by 1 mg/day of prednisolone was not associated with increased risk of overall or severe flare: adjusted HRs 1.02 (95% CI, 0.99 to 1.05) and 0.98 (95% CI, 0.96 to 1.004), respectively. Antimalarial use was associated with decreased flare risk. Tapering GCs was associated with decreased risk of damage accrual (adjusted HR 0.96, 95% CI, 0.93 to 0.99) in the patients whose initial prednisolone dosages were >5 mg/day.
Conclusions: In mSACQ patients, tapering GCs was not associated with increased flare risk. Antimalarial use was associated with decreased flare risk. Tapering GCs protected mSACQ patients treated with >5 mg/day of prednisolone against damage accrual. These findings suggest that cautious GC tapering is feasible and can reduce GC use in mSACQ patients.
期刊介绍:
Annals of the Rheumatic Diseases (ARD) is an international peer-reviewed journal covering all aspects of rheumatology, which includes the full spectrum of musculoskeletal conditions, arthritic disease, and connective tissue disorders. ARD publishes basic, clinical, and translational scientific research, including the most important recommendations for the management of various conditions.