Effects of Glucocorticoid Withdrawal on Relapse Risk in Systemic Lupus Erythematosus

Glucocorticoids (GCs) remain one of the mainstays of treatment in Systemic Lupus Erythematosus (SLE), particularly during active disease phases when they can rapidly control inflammation and alleviate symptoms. However, long-term glucocorticoid use is associated with numerous adverse effects. In particular, whether it is safe to withdraw glucocorticoids during the stable phase of SLE remains an unresolved question. Given the rising of this groundbreaking approach, we summarized a dataset of GC withdrawal versus maintenance studies (RCTs/cohort studies).
Data source: PubMed, Embase, and the Cochrane Library.
Search strategy: Strategies are provided in the file " Extraction process".
Eligibility criteria: Studies identified through title and abstract screening were required to meet the following inclusion criteria: studies involving SLE patients, RCTs or cohort studies, and reporting relapse outcomes for both the glucocorticoid withdrawal and maintenance groups. Exclusion criteria included studies involving pregnant women, patients undergoing stem cell transplantation, and patients with other conditions that might affect glucocorticoid discontinuation. In cases of overlapping patient populations or duplicate publications, the report providing the most complete data or addressing different outcome measures was retained. There were no restrictions regarding age, ethnicity, sex, or concurrent therapies.
Data extraction: Data was extracted using a predefined standardized form, which included information on the authors, publication year, country, study design, data source, sample size, demographic and clinical characteristics, and target outcome measures. The primary outcome of the meta-analysis was to evaluate the impact of glucocorticoid withdrawal on the overall relapse rate in SLE patients, while secondary analyses focused on the incidence of severe relapses and mild/moderate relapses. Relapse was defined according to each study's criteria and was assessed using clinical symptoms, laboratory tests, and standardized scoring systems (e.g., Systemic Lupus Erythematosus Disease Activity Index [SLEDAI], British Isles Lupus Assessment Group [BILAG], Physician Global Assessment [PGA]). Relapse severity was categorized based on the SELENA-SLEDAI Flare Index (SFI) into mild/moderate and severe activity.
Statistical analysis: Data were entered into Excel and analyzed using RevMan 5.4. See in "GC withdrawal versus GC maintenance for SLE flare".