Glucocorticoid-free remission in patients with SLE in the era of biologics: Immune complex disease is likely to benefit from current medications

Lupus. 2024 Apr;33(5):502-510. doi: 10.1177/09612033241238055. Epub 2024 Mar 12.

Abstract

Objectives: In addition to various immunosuppressive agents, belimumab and anifrolumab became available in Japan. We aimed to investigate glucocorticoid-free clinical remission in a single-centre retrospective cohort in October 2023.

Methods: Our cohort included patients with SLE who needed to start or increase glucocorticoids for disease activity and were followed up for more than 1 year. We investigated the rate of achievement of clinical remission off corticosteroids (CR off C), defined as no clinical score on the SLEDAI-2K without glucocorticoids, baseline predictors of CR off C, medications used when CR off C was achieved, and flare rates following CR off C.

Results: Out of the 60 patients followed for an average of 5.4 (±2.6) years, 17 (28.3%) achieved CR off C in 3.6 (±1.2) years after enrolment. Use of belimumab and anifrolumab accounted for eight (47.1%) of the achievers. Among the baseline data, male sex, recent enrolment, high glucocorticoid dose, and detection of immune complex (IC) significantly predicted CR off C, while lupus nephritis (LN) and a low C3 level tended to predict it. In the multivariate analysis, IC detection was the only predictor of CR off C. Clinical flares were observed in 5.9% of the achievers during a median 1.2 years after achievement of CR off C.

Conclusion: In the era of biologics, CR off C was achieved in 28.3% of the patient cohort requiring the start or increase of glucocorticoids for disease activity, with a relatively low rate of flares, suggesting that glucocorticoid-free clinical remission is an achievable target in SLE. IC disease, represented by male sex or nephritis, is likely to benefit from currently available medications.

Keywords: Systemic lupus erythematosus; anifrolumab; belimumab; clinical remission off corticosteroids.

MeSH terms

  • Antigen-Antibody Complex
  • Biological Products* / therapeutic use
  • Glucocorticoids / therapeutic use
  • Humans
  • Immune Complex Diseases* / drug therapy
  • Immunosuppressive Agents / therapeutic use
  • Lupus Erythematosus, Systemic* / drug therapy
  • Male
  • Retrospective Studies
  • Severity of Illness Index

Substances

  • Glucocorticoids
  • Biological Products
  • Immunosuppressive Agents
  • Antigen-Antibody Complex