Does Withdrawing Steroids Increase Flares? Save
Dr. Janet Pope reports on abstract OP0180 presented at Eular 2024 in Vienna, Austria.
Transcription
Hi, I'm Doctor. Janet Pope or JanetBurdeau reporting at RheumNow at ULAr2024 in beautiful Vienna, Austria. I'd like to talk about glucocorticoids in SLE, and I wanna tell you about three things. So I'm going to tell you background, and then I'm going to talk about oral presentation OP0180. So rumor has it in past that when we withdraw glucocorticoids in people with SLE or lupus who are in clinical remission, that many of them flare.
And we've all had patients where they're on four or six milligrams of prednisone, and as we go down, they feel worse, or they actually clinically flare and they go back up to the dose that they were on that we're trying to get them off of. This study was to look at if patients were in clinical and serological remission, so a SLEED eye score of zero, so that's no active lupus by complements or double stranded DNA, and no clinical lupus, and they're on low dose prednisone, less than or equal to five milligrams a day, and stable immune suppression. And what they did was they looked at people retrospectively, not randomized, but those who got off glucocorticoids and those who really couldn't get down. And they looked at the rate of flares, and a flare was saying that their lupus disease activity index went up above zero. So it could have been inflammatory arthritis or a low complement double stranded DNA.
And in this study, they had three sixty patients who were able to get off their low dose prednisone, and about a quarter or one hundred and twenty four who couldn't. And they looked at the flares and the time to flares. And basically the annual flare rate, if you got off prednisone, was one point six five per one hundred patient years, and it was eight point five per 100 patient years who stayed on prednisone. So the conclusion was, number one, if you get off prednisone, you don't have more flares. But number two, this study is biased because the people who didn't get off prednisone probably knew that they had to keep it on board or they would flare, and if you tried to insist and you got them changed up a little bit, but not off prednisone, they flared, so the patients probably knew and maybe the physicians knew.
And number three, there is a PASS randomized controlled trial of low dose prednisone in lupus, And if you're randomized to a very slow taper versus keeping them fixed at say five milligrams a day, there is a higher flare rate. So this study is contrary and opposite to the RCT. And I think the take home message is if you're trying to taper and the people flare, just put them back on the previous dose. If you're trying to taper and they're not flaring, try to get them off prednisone altogether. So three items that will help you when you're treating your patients on low dose prednisone who are in full remission from their lupus.
Please follow us at RheumNow and enjoy your day. Thank you.
And we've all had patients where they're on four or six milligrams of prednisone, and as we go down, they feel worse, or they actually clinically flare and they go back up to the dose that they were on that we're trying to get them off of. This study was to look at if patients were in clinical and serological remission, so a SLEED eye score of zero, so that's no active lupus by complements or double stranded DNA, and no clinical lupus, and they're on low dose prednisone, less than or equal to five milligrams a day, and stable immune suppression. And what they did was they looked at people retrospectively, not randomized, but those who got off glucocorticoids and those who really couldn't get down. And they looked at the rate of flares, and a flare was saying that their lupus disease activity index went up above zero. So it could have been inflammatory arthritis or a low complement double stranded DNA.
And in this study, they had three sixty patients who were able to get off their low dose prednisone, and about a quarter or one hundred and twenty four who couldn't. And they looked at the flares and the time to flares. And basically the annual flare rate, if you got off prednisone, was one point six five per one hundred patient years, and it was eight point five per 100 patient years who stayed on prednisone. So the conclusion was, number one, if you get off prednisone, you don't have more flares. But number two, this study is biased because the people who didn't get off prednisone probably knew that they had to keep it on board or they would flare, and if you tried to insist and you got them changed up a little bit, but not off prednisone, they flared, so the patients probably knew and maybe the physicians knew.
And number three, there is a PASS randomized controlled trial of low dose prednisone in lupus, And if you're randomized to a very slow taper versus keeping them fixed at say five milligrams a day, there is a higher flare rate. So this study is contrary and opposite to the RCT. And I think the take home message is if you're trying to taper and the people flare, just put them back on the previous dose. If you're trying to taper and they're not flaring, try to get them off prednisone altogether. So three items that will help you when you're treating your patients on low dose prednisone who are in full remission from their lupus.
Please follow us at RheumNow and enjoy your day. Thank you.
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