Additional B‐Lymphocyte Stimulator Inhibitors Treatment Facilitated Glucocorticoid Withdrawal in Lupus Nephritis Patients: A Real‐World Retrospective Observational Single‐Center Cohort Study

ABSTRACT

Glucocorticoid (GC) withdrawal remains a major challenge for lupus nephritis (LN). In this 20‐year retrospective cohort, we evaluated whether B‐lymphocyte stimulator (BLyS) inhibitors facilitated GC discontinuation. Among 702 LN patients, 553 were treated with standard‐of‐care alone, and 149 received add‐on BLyS inhibitors (belimumab or telitacicept). Patients receiving BLyS inhibitors achieved a higher rate of GC withdrawal than those receiving standard‐of‐care alone (10.7% vs. 5.61%, p = 0.026). Kaplan–Meier analysis confirmed a higher cumulative incidence of GC withdrawal in the BLyS inhibitor group ( p = 0.001). After adjusting for age, sex, Systemic Lupus Erythematosus Disease Activity Index, acute kidney injury, nephrotic syndrome, and renal histopathology, time‐dependent Cox regression revealed that BLyS inhibitor therapy was independently associated with a higher GC withdrawal rate (hazard ratio [HR] = 7.97, 95% confidence interval [CI]: 4.11–15.5, p  < 0.001). Exploratory subgroup analyses indicated that among GC‑discontinued patients, Class IV LN predominated in the BLyS inhibitor group, whereas Class V LN was more prevalent in controls. During follow‐up, no renal flares occurred in BLyS inhibitor‐treated patients who discontinued GCs, though there was no significant between‐group difference. In conclusion, add‐on BLyS inhibitor therapy may serve as a potential steroid withdrawal‐permissive approach for LN, pending further prospective validation of its clinical applicability.