Objective To describe frequency and characteristics of SLE patients in glucocorticoids (GC)-free remission in a real-life setting.

Methods This is a retrospective analysis of prospectively collected data from a monocentric SLE cohort. The following variables were retrieved: demographic data, cumulative organ involvement; at last observation: disease activity (SLEDAI-2K score), ongoing therapy, disease state (remission defined according to the 2021 DORIS criteria) and organ damage (SDI score).

Results From our cohort, a total of 390 SLE patients (87.4% female, all Caucasian) had at least 1 year of follow-up and complete clinical data to be included in the analysis. At last evaluation, the mean follow-up duration was 11.1 years (min 1-max 42) and 293 patients (75.1%) were in remission. Of these, 141 (36.2%) were in GC-free remission (GC-), and 44 of them (11.2%) were GC-free for 5 years. Characteristics of patients in remission, as well as the comparison between GC- group and remitted patients under GC treatment (GC+) are reported in table 1.

No significant differences were found with regard to age, organ involvement and disease duration at last evaluation between the two groups. However, mean cumulative GC dose was significantly higher in GC+ group (24.7±27.7 vs 14.7±13.3, p<0.01).

Being GC- at last observation was associated with a significantly lower organ damage with respect to GC+ (mean SDI 0.7±1.1 vs 1.5±2.0, p<0.01). In particular, significant differences regarded cardiovascular events (5.0% vs 13.6%, p=0.01) and osteoporosis (12.1% vs 30.3%, p<0.01) were found, and GC+ patients had also more frequently concomitant diagnosis of hypertension (35.5% vs 22.7%, p=0.01).

Conclusions GC-free remission is an achievable goal in SLE patients and it is sustained over time in a good proportion of patients. Our study also confirms that GC withdrawal has important advantages in term of organ-damage sparing; indeed, GC-patients at last observation were presenting less organ damage, especially GC-related organ damage.