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PO.6.133 Dynamical trajectory of glucocorticoid tapering and discontinuation in real-world patients with newly diagnosed systemic lupus erythematosus: the gulp study
  1. M Piga1,
  2. E Chessa2,
  3. A Floris1,
  4. GD Sebastiani3,
  5. I Prevete3,
  6. F Iannone4,
  7. L Coladonato4,
  8. M Govoni5,
  9. A Bortoluzzi5,
  10. M Mosca6,
  11. C Tani7,
  12. A Doria8,
  13. L Iaccarino8,
  14. F Franceschini9,
  15. M Fredi9,
  16. F Conti10,
  17. FR Spinelli10,
  18. F Bellisai11,
  19. R D’Alessandro11,
  20. A Zanetti12,
  21. G Carrara12,
  22. CA Scirè12 and
  23. A Cauli1
  1. 1UOC Reumatologia, AOU Cagliari, Monserrato, Italy; Reumatologia, Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari ~ Italy
  2. 2UOC Reumatologia, AOU Cagliari, Monserrato ~ Cagliari ~ Italy
  3. 3UOC di Reumatologia, Azienda Ospedaliera San Camillo-Forlanini ~ Roma ~ Italy
  4. 4Dipartimento dell’Emergenza e dei Trapianto di Organi – Sezione di Reumatologia, Università di Bari ~ Italy
  5. 5UOC e Sezione di Reumatologia – Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Dipartimento di Scienze Mediche, Università degli Studi di Ferrara ~ Italy
  6. 6U.O. Reumatologia, Azienda Ospedaliero Universitaria Pisana, Pisa; Reumatologia, Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa ~ Italy
  7. 7U.O. Reumatologia, Azienda Ospedaliero Universitaria Pisana ~ Pisa ~ Italy
  8. 8Rheumatology Unit, Department of Medicine – DIMED, University of Padova ~ Italy
  9. 9UOC di Reumatologia e Immunologia Clinica, Dipartimento di Scienze Cliniche e Sperimentali, Università degli Studi di Brescia, ASST Spedali Civili ~ Brescia ~ Italy
  10. 10Sezione di Reumatologia; Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma ~ Italy
  11. 11UOC di Reumatologia, Azienda Ospedaliera Universitaria Senese ~ Siena ~ Italy
  12. 12Società Italiana di Reumatologia, Unità Epidemiologica, Italy. 13 – Dipartimento di Statistica e Metodi Quantitativi, Divisione di Biostatistica, Epidemiologia e Salute Pubblica, Università degli Studi di Milano-Bicocca ~ Milano ~ Italy


Purpose Glucocorticoids (GCs) are recommended in patients with systemic lupus erythematosus (SLE), in combination with hydroxychloroquine (HCQ) or immunosuppressant, but should be tapered or discontinued in the medium to long-term to minimize detrimental effects. A sub-analysis of the multicenter Early Lupus inception cohort was performed to investigate the real-world trajectory of Glucocorticoids (GCs) Use in newly diagnosed SLE Patients (the GULP study) and the associated outcomes.

Methods The GULP study enrolled patients starting prednisone (PDN) ≥5mg/day and concomitant HCQ or immunosuppressant within 12 months of SLE classification. SLE core set variables were recorded at baseline and then every six months for 2 years, including changes in PDN dose, ECLAM and BILAG active domains. The SLICC/ACR Damage Index (SDI) and a 0–10 global health visual analog scale (GH-VAS) were also recorded. Regression models analyzed the damage accrual and GH-VAS in different GCs tapering and discontinuation trajectories.

Results Overall, 127 SLE patients with a mean age of 36.7 (± 13.4) years and a median disease duration of 6.1 (1.3 - 11.5) months were included. At baseline 98 (77.2%) patients received HCQ, 81 (63.8%) received conventional immunosuppressants, and 57 (44.9%) received a combination of them. The median daily dose of PDN at baseline was 12.5 (6.3–25.0) mg/day and significantly decreased to 5.4 (4.3–9.4) mg/day at 12-month and 4.9 (2.5–6.6) mg/day at 24-month (p<0.001). At the end of follow-up, 73 (57.5%) successfully tapered PDN doses below 5 mg/day, and 17 (13.4%) discontinued GCs within a 2-year follow-up (Figure 1). Overall, 99 (78%) patients tapered the PDN dose below 5 mg/day: 34 (26.8%) within 6 months, 35 (27.6%) within 12 months, 22 (17.3%) within 18 months and 8 (6.3%) within 24 months of follow-up; 42.4% of patients who tapered PDN and 46.4% of those who never tapered PDN below 5mg/day required to increase the PDN dose within the end of the 2-year follow-up. A higher daily dose of PDN resulted in a greater probability (OR 1.4 per mg/day; 95%CI 1.3–1.5; p<0.001) of GCs tapering regardless of disease activity, whereas ECLAM (OR 1.6; 95%CI 1.2–2.3; p=0.004) and BILAG (OR 1.9; 95%CI 1.3–3.0; p=0.004) were independently associated with the risk of increasing GCs dose. In patients taking PDN <5mg/day, daily doses remained stable in 49.3% and 52.8% of visits despite, respectively, ECLAM=0 and no BILAG activity. Every month spent on PDN<5mg/day was associated with lower damage accrual (IRR 0.96; 95%CI 0.93–0.99; p=0.007) and better GH-VAS (beta 0.60; 95%CI 0.13–1.33; p=0.108), although the latter was statistically nonsignificant.

Abstract PO.6.133 Figure 1

Heatmap of the mean daily prednisone dose interval during the 24 months follow-up since diagnosis

Conclusion GCs are feasibly tapered to PDN <5mg/day maintenance dose with adequate control of disease activity and lowered damage in patients with newly diagnosed SLE, whereas physicians usually avoid GCs discontinuation in the early disease stage.

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