Factors Associated with Glucocorticoid Withdrawal in Systemic Lupus Erythematosus: A Multicentre ANSWER-SLE Cohort
Haruna Fujiki, Ryu Watanabe, Ryuhei Ishihara, Masao Katsushima, Yuhei Fujisawa, Akira Onishi, Hideaki Tsuji, Takuya Kotani, Yumiko Wada, Yuji Nozaki, Toshihiko Shiga, Shuji Sumitomo, Hideki Oka, Hirofumi Miyake, Takao Fujii, Shigeru Iwata, Yasuhiro Kato, Eri Itotagawa, Wataru Yamamoto, Yuya Fujita, Kazuo Fukumoto, Shinsuke Yamada, Motomu HashimotoAbstract
Objectives
To examine the rate of glucocorticoid (GC) discontinuation and to identify factors associated with successful GC withdrawal in patients with systemic lupus erythematosus (SLE).
Methods
This multicentre retrospective study used data from the ANSWER-SLE cohort. Patients fulfilling the 2019 ACR/EULAR classification criteria and registered between October 2023 and May 2025 were included. Patients were classified by GC status at enrolment as follows: discontinued GCs (Group 1), GC-naïve (Group 2), or continuing GC therapy (Group 3).
Results
Among 1,689 patients, 107 (6.3%) were in Group 1, 130 (7.7%) in Group 2, and 1,452 (86.0%) in Group 3. Disease duration was longest in Group 3 (P<0.001). Group 2 had lower total 2019 classification scores (P=0.008), higher LLDAS attainment (P<0.001), and lower SLICC Damage Index scores (P<0.001). Group 1 had the highest concomitant use of hydroxychloroquine (HCQ) (P<0.001), mycophenolate mofetil (MMF) (P<0.001), and belimumab (P=0.001). In multivariable Cox regression analysis, older age at disease onset (HR=1.049, P<0.001), HCQ (HR=5.75, P<0.001), MMF (HR=1.82, P=0.009), and belimumab (HR=1.72, P=0.041) were independently associated with GC discontinuation.
Conclusion
GC withdrawal may be achievable in selected patients with SLE, particularly those receiving HCQ, MMF, and belimumab, and in patients with an older age at disease onset.