At the CRA 2015 meeting in Quebec City, Dr. Zahi Touma presented an oral paper titled: "Successful Withdrawal and Discontinuation of Immunosuppressants in Lupus Patients: Outcomes and Predictors." Patients from the Toronto Lupus Clinic were followed from 1987-2012 and included in this study if they were in clinical remission and taking 7.5 mg of prednisone daily or less. There were 973 patients on immunosuppressants (IS) out of 1678. Of these, 179 had some tapering and 99 were able to stop IS. The length of time from tapering to stopping treatment was 1.8±1.8 years in the no flare and 0.9±0.9 years in the flare group.
This demonstrates that we should taper IS very slowly to decrease the chance of SLE flaring. The longer patients were followed, the more likely they were to flare (at least in the first 3 years) with 1 in 6 at one year, 1 in 3 at 2 years and 1 in 2 over years 3, 4 and 5. Patients were more likely to flare if they were on prednisone, which is possibly due to the fact that the patients previously required prednisone due to disease activity. However, it also shows us that being on chronic prednisone is a predictor of less chance of stopping IS successfully.
The importance of this analysis is that it shows us that some SLE patients can successfully decrease and stop their treatment in SLE but there is a 50/50 chance of flare by 3 years, especially if on stable chronic low-dose steroids.
Dr. Janet Pope is Professor of Medicine at Western University and Division Head of Rheumatology. Dr. Pope's research interests include epidemiologic studies in scleroderma, classification criteria in systemic sclerosis, systemic lupus erythematosus and rheumatoid arthritis.View Full Bio