Rudra Prosad Goswami1, Hiramanik Sit1, Parasar Ghosh2, Geetabali Sircar1, Alakendu Ghosh1. 1. Department of Rheumatology, Institute of Post Graduate Medical Education and Research, 240 AJC Bose Road, Kolkata, West Bengal, India. 2. Department of Rheumatology, Institute of Post Graduate Medical Education and Research, 240 AJC Bose Road, Kolkata, West Bengal, India. drparasar@gmail.com.
Abstract
OBJECTIVE: Whether maintaining steroid-free remission is feasible in Indian patients with systemic lupus erythematosus (SLE). METHODS: In 148 patients with SLE including 78 lupus nephritis (LN) previously put into remission, steroid therapy was gradually tapered off. RESULTS: Patients received glucocorticoids for median 1855 days (interquartile range (IQR) 901-2834) before discontinuing. Median duration of follow-up was 539 days (IQR 266.25-840.75). Flare occurred in 31 patients (20.9%; 95% confidence interval (CI) 15.17-28.19, renal flare in 12.16% (18/148, 95% CI 7.83-18.41)). Most of the flares occurred in the first year of follow-up (41.9%, 13/31). Overall 93.5% (29/31) of flares occurred in those who received ≤ 8 years of glucocorticoids, compared to 6.5% (2/31) of flares in others (p = 0.009). Median flare-free survival was 611 days (95% CI 518-704). Multivariate Cox regression identified the following predictors of flare-free survival: duration of disease (hazard ratio (HR) 0.89, 95% CI 0.84-0.94, p < 0.001), duration of glucocorticoid before discontinuing (HR 1.000086, 95% CI 1.000047-1.00012, p < 0.001) and second immunosuppressive (HR 1.89, 95% CI 1.251-2.87, p = 0.003). Additional risk factors of a renal flare-free survival among patients with LN were initial dose of glucocorticoids (HR 0.97, 95% CI 0.94-0.99, p = 0.005) and presence of haemolytic anaemia (HR 2.43, 95% CI 1.067-5.54, p = 0.035). CONCLUSIONS: About 20% patients undergo exacerbation of disease activity after glucocorticoid withdrawal. Treatment for ≥ 8 years before discontinuing and an additional immunosuppressive agent improve the chance of flare-free survival.
OBJECTIVE: Whether maintaining steroid-free remission is feasible in Indian patients with systemic lupus erythematosus (SLE). METHODS: In 148 patients with SLE including 78 lupus nephritis (LN) previously put into remission, steroid therapy was gradually tapered off. RESULTS:Patients received glucocorticoids for median 1855 days (interquartile range (IQR) 901-2834) before discontinuing. Median duration of follow-up was 539 days (IQR 266.25-840.75). Flare occurred in 31 patients (20.9%; 95% confidence interval (CI) 15.17-28.19, renal flare in 12.16% (18/148, 95% CI 7.83-18.41)). Most of the flares occurred in the first year of follow-up (41.9%, 13/31). Overall 93.5% (29/31) of flares occurred in those who received ≤ 8 years of glucocorticoids, compared to 6.5% (2/31) of flares in others (p = 0.009). Median flare-free survival was 611 days (95% CI 518-704). Multivariate Cox regression identified the following predictors of flare-free survival: duration of disease (hazard ratio (HR) 0.89, 95% CI 0.84-0.94, p < 0.001), duration of glucocorticoid before discontinuing (HR 1.000086, 95% CI 1.000047-1.00012, p < 0.001) and second immunosuppressive (HR 1.89, 95% CI 1.251-2.87, p = 0.003). Additional risk factors of a renal flare-free survival among patients with LN were initial dose of glucocorticoids (HR 0.97, 95% CI 0.94-0.99, p = 0.005) and presence of haemolytic anaemia (HR 2.43, 95% CI 1.067-5.54, p = 0.035). CONCLUSIONS: About 20% patients undergo exacerbation of disease activity after glucocorticoid withdrawal. Treatment for ≥ 8 years before discontinuing and an additional immunosuppressive agent improve the chance of flare-free survival.