Background and Aims

To evaluate the rate and features of SLE patients who successfully tapered prednisone (equivalent) below 5 mg/day, within 2-year since diagnosis, in a real-life prospective study.

Methods

The Early Lupus Project recruited a multicenter inception cohort of patients within 12 months of SLE diagnosis. At enrolment and then every 6 months a panel of data (including demographic, comorbidities, serologic, clinic by BILAG2004 domains, ECLAM, HRQoL, and treatment) was recorded. Forward-Backward Cox-regression models were fitted with covariates with univariate p<0.05 to identify baseline factors independently associated with the successful tapering of prednisone below 5 mg/day.

Results

Overall, 127 patients (17.3% males) were eligible for this study having at least a 24-month follow-up and a prednisone dose ≥5 mg at enrolment. Mean age was 36.7 (±13.4), median disease duration was 183 (40 - 346) days and prednisone dose at baseline was 17.9 (±14.4) mg/day. During the 2-year follow-up, 99 patients (78%) tapered the prednisone dose <5 mg/day (see Figure 1). However, 42/99 (42.4%) required to increase the prednisone dose ≥5 mg/day because of inadequate disease activity control within the end of the 2-year follow-up. Only 17/127 (13.4%) patients successfully discontinued prednisone treatment.

Hematologic (HR 0.41; p<0.001) and renal (HR 0.54; p=0.019) involvement, SDI≥1 (HR 0.55; p=0.022), and C3 complement levels (HR 1.04; P=0.021) at baseline were negatively associated with the successful tapering of prednisone < 5mg/day which was not influenced by baseline dose and concomitant medications.

Conclusions

Prednisone tapering below 5 mg/day is achievable within 2-years since diagnosis by more than half of patients.