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...
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my.um.eprints.470392025-01-06T04:40:22Z http://eprints.um.edu.my/47039/ 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 Katsumata, Yasuhiro Inoue, Eisuke Harigai, Masayoshi Cho, Jiacai Louthrenoo, Worawit Hoi, Alberta Golder, Vera Lau, Chak Sing Lateef, Aisha Chen, Yi-Hsing Luo, Shue-Fen Wu, Yeong-Jian Jan Hamijoyo, Laniyati Li, Zhanguo Sockalingam, Sargunan Navarra, Sandra Zamora, Leonid Hao, Yanjie Zhang, Zhuoli Chan, Madelynn Oon, Shereen Ng, Kristine Kikuchi, Jun Takeuchi, Tsutomu Goldblatt, Fiona O'Neill, Sean Tugnet, Nicola Law, Annie Hui Nee Bae, Sang-Cheol Tanaka, Yoshiya Ohkubo, Naoaki Kumar, Sunil Kandane-Rathnayake, Rangi Nikpour, Mandana Morand, Eric F. R Medicine (General) 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. BMJ Publishing Group 2024-08 Article PeerReviewed Katsumata, Yasuhiro and Inoue, Eisuke and Harigai, Masayoshi and Cho, Jiacai and Louthrenoo, Worawit and Hoi, Alberta and Golder, Vera and Lau, Chak Sing and Lateef, Aisha and Chen, Yi-Hsing and Luo, Shue-Fen and Wu, Yeong-Jian Jan and Hamijoyo, Laniyati and Li, Zhanguo and Sockalingam, Sargunan and Navarra, Sandra and Zamora, Leonid and Hao, Yanjie and Zhang, Zhuoli and Chan, Madelynn and Oon, Shereen and Ng, Kristine and Kikuchi, Jun and Takeuchi, Tsutomu and Goldblatt, Fiona and O'Neill, Sean and Tugnet, Nicola and Law, Annie Hui Nee and Bae, Sang-Cheol and Tanaka, Yoshiya and Ohkubo, Naoaki and Kumar, Sunil and Kandane-Rathnayake, Rangi and Nikpour, Mandana and Morand, Eric F. (2024) 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. Annals of the Rheumatic Diseases, 83 (8). pp. 998-1005. ISSN 0003-4967, DOI https://doi.org/10.1136/ard-2023-225369 <https://doi.org/10.1136/ard-2023-225369>. https://doi.org/10.1136/ard-2023-225369 10.1136/ard-2023-225369 |
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R Medicine (General) Katsumata, Yasuhiro Inoue, Eisuke Harigai, Masayoshi Cho, Jiacai Louthrenoo, Worawit Hoi, Alberta Golder, Vera Lau, Chak Sing Lateef, Aisha Chen, Yi-Hsing Luo, Shue-Fen Wu, Yeong-Jian Jan Hamijoyo, Laniyati Li, Zhanguo Sockalingam, Sargunan Navarra, Sandra Zamora, Leonid Hao, Yanjie Zhang, Zhuoli Chan, Madelynn Oon, Shereen Ng, Kristine Kikuchi, Jun Takeuchi, Tsutomu Goldblatt, Fiona O'Neill, Sean Tugnet, Nicola Law, Annie Hui Nee Bae, Sang-Cheol Tanaka, Yoshiya Ohkubo, Naoaki Kumar, Sunil Kandane-Rathnayake, Rangi Nikpour, Mandana Morand, Eric F. 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 |
| description |
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. |
| format |
Article |
| author |
Katsumata, Yasuhiro Inoue, Eisuke Harigai, Masayoshi Cho, Jiacai Louthrenoo, Worawit Hoi, Alberta Golder, Vera Lau, Chak Sing Lateef, Aisha Chen, Yi-Hsing Luo, Shue-Fen Wu, Yeong-Jian Jan Hamijoyo, Laniyati Li, Zhanguo Sockalingam, Sargunan Navarra, Sandra Zamora, Leonid Hao, Yanjie Zhang, Zhuoli Chan, Madelynn Oon, Shereen Ng, Kristine Kikuchi, Jun Takeuchi, Tsutomu Goldblatt, Fiona O'Neill, Sean Tugnet, Nicola Law, Annie Hui Nee Bae, Sang-Cheol Tanaka, Yoshiya Ohkubo, Naoaki Kumar, Sunil Kandane-Rathnayake, Rangi Nikpour, Mandana Morand, Eric F. |
| author_facet |
Katsumata, Yasuhiro Inoue, Eisuke Harigai, Masayoshi Cho, Jiacai Louthrenoo, Worawit Hoi, Alberta Golder, Vera Lau, Chak Sing Lateef, Aisha Chen, Yi-Hsing Luo, Shue-Fen Wu, Yeong-Jian Jan Hamijoyo, Laniyati Li, Zhanguo Sockalingam, Sargunan Navarra, Sandra Zamora, Leonid Hao, Yanjie Zhang, Zhuoli Chan, Madelynn Oon, Shereen Ng, Kristine Kikuchi, Jun Takeuchi, Tsutomu Goldblatt, Fiona O'Neill, Sean Tugnet, Nicola Law, Annie Hui Nee Bae, Sang-Cheol Tanaka, Yoshiya Ohkubo, Naoaki Kumar, Sunil Kandane-Rathnayake, Rangi Nikpour, Mandana Morand, Eric F. |
| author_sort |
Katsumata, Yasuhiro |
| 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 |
| title_short |
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 |
| title_full |
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 |
| title_fullStr |
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 |
| title_full_unstemmed |
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 |
| title_sort |
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 |
| publisher |
BMJ Publishing Group |
| publishDate |
2024 |
| url |
http://eprints.um.edu.my/47039/ https://doi.org/10.1136/ard-2023-225369 |
| _version_ |
1821105757630758912 |
| score |
13.226497 |