Steroid-Free Lupus Nephritis Treatment Gains Ground With New Predictive Insights
A 30-year study from Greece highlights how early remission and continued hydroxychloroquine use may help patients with lupus nephritis safely stop corticosteroids.
Researchers have identified key predictors that may allow patients with lupus nephritis to successfully discontinue steroid therapy potentially reducing long-term organ damage without increasing flare risk.
Study Details
Lupus nephritis, a kidney complication of systemic lupus erythematosus (SLE), often requires prolonged corticosteroid treatment to prevent flares and preserve renal function. However, long-term steroid use carries serious side effects such as weight gain, bone loss, diabetes, and infection risk.
To better understand how and when steroids can be safely stopped, investigators at the National and Kapodistrian University of Athens followed 136 biopsy-confirmed lupus nephritis patients from 1992 to 2021, analyzing treatment patterns and long-term outcomes.
Methodology
All participants were treated with steroids alongside immunosuppressive therapy. Researchers assessed renal function, lupus disease activity, and flare incidence annually. They specifically looked at the relationship between early disease control and the likelihood of successful steroid withdrawal.
Key indicators like renal remission, lupus activity scores, and maintenance of hydroxychloroquine use were tracked as potential predictors of successful discontinuation.
Key Findings
Steroid cessation was achievable for most patients: 86% of participants eventually discontinued steroids, with a median withdrawal time of 29 months.
Early disease control mattered: Patients achieving complete renal and lupus remission within the first year were significantly more likely to discontinue steroids successfully.
Hydroxychloroquine use was protective: Continued use during tapering reduced both flare risk and long-term organ damage.
Flare risk was modest and predictable: About one in four patients had a flare after stopping steroids, typically two years later, but those who achieved low disease activity and remained on hydroxychloroquine fared best.
Organ protection benefits: Each additional month of steroid use increased organ damage risk by 2%, underscoring the benefit of timely tapering.
Implications for Practice
For clinicians, the study offers data-driven guidance to individualize steroid tapering in lupus nephritis. Patients who reach renal and systemic remission early and maintain hydroxychloroquine therapy may be strong candidates for earlier withdrawal.
For patients, this provides reassurance that steroid-free management is possible with consistent follow-up, adherence to therapy, and clear communication with their care team.
“Maintaining both renal response and overall low disease activity could become key treatment targets for lupus nephritis,” said study author Dr. Maria Tektonidou.