Prednisolone maintenance minimises relapse in quiescent SLE

Corticosteroids play an important role in the management of systemic lupus erythematosus (SLE).

While it is recognised that these drugs should not be used in the longer-term due to toxicity, corticosteroids are often continued as maintenance therapy in order to prevent a disease release.

For this new study, a French team of researchers examined whether withdrawal of corticosteroids in patients with quiescent disease would lead to a disease flare. They randomised 123 patients to either maintenance therapy (prednisolone 5mg/daily) or stopping the drug for a period of 12 months.

Included patients had clinically stable disease over the preceding year and prednisolone 5mg/day as part of their treatment regime. The primary outcome was the proportion of patients experiencing a flare at 52 weeks. The results showed that the proportion of patients experiencing a disease flare was significantly less in the maintenance group compared to the withdrawal group (7% vs 27%). When looking at the severity of flares, it was also clear that those in the maintenance group experienced a significantly lower proportion of moderate/severe flares. Interestingly there were no differences in adverse events between the two groups.

The authors called for further studies in larger patient cohorts to validate their preliminary findings.

Reference
Mathian A et al. Withdrawal of low-dose prednisolone in SLE patients with clinically quiescent disease for more than 1 year: a randomised clinical trial. Ann Rheum Dis 2020;79:339-46.