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Meta-Analysis
. 2022 Jan;9(1):e000603.
doi: 10.1136/lupus-2021-000603.

Risk factors of flare in patients with systemic lupus erythematosus after glucocorticoids withdrawal. A systematic review and meta-analysis

Lanlan Ji #  1 , Wenhui Xie #  1 , Serena Fasano  2 , Zhuoli Zhang  3
Affiliations
Meta-Analysis

Risk factors of flare in patients with systemic lupus erythematosus after glucocorticoids withdrawal. A systematic review and meta-analysis

Lanlan Ji et al. Lupus Sci Med. 2022 Jan.

Abstract

Objective: Glucocorticoids (GC) withdrawal is part of the targets in current recommendations for SLE, but relapse is the most worrying issue. We aimed to investigate the predictors for flare in patients with SLE after GC withdrawal.

Methods: We systematically searched PubMed, EMBASE and Cochrane Library as well as Scopus databases up to 9 July 2021 for studies concerning predictive factors of relapses in patients with SLE after GC cessation. Pooled OR and 95% CI were combined using a random-effects or fixed-effects model.

Results: 635 patients with SLE with GC discontinuation in 9 publications were eligible for the final analysis. Of them, 99.5% patients were in clinical remission before GC withdrawal. Serologically active yet clinically quiescent (SACQ) was associated with an increased risk of flare after GC withdrawal (OR 1.78, 95% CI (1.00 to 3.15)). Older age and concomitant use of hydroxychloroquine (HCQ) trended towards decreased risk of flare (weighted mean difference (WMD) -2.04, 95% CI (-4.15 to 0.06) for age and OR 0.50, 95% CI (0.23 to 1.07) for HCQ), yet not statistically significant. No significant association was observed regarding gender (pooled OR 1.75; 95% CI (0.59 to 5.20)), disease duration (WMD -11.91, 95% CI (-27.73 to 3.91)), remission duration (WMD -8.55, 95% CI (-33.33 to 16.23)), GC treatment duration (WMD -10.10, 95% CI (-64.09 to 43.88)), concomitant use of immunosuppressant (OR 0.86, 95% CI (0.48 to 1.53)).

Conclusion: Younger age and SACQ were potential risk factors of SLE flare among patients who discontinued GC. HCQ, but not immunosuppressant might prevent flare. GC withdrawal should be done with caution in this subgroup of patients.

Keywords: glucocorticoids; lupus erythematosus; lupus nephritis; systemic.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
The flow chart of study selection.
Figure 2
Figure 2
Forest plots of the weighted mean difference (WMD) and HR for the risk of flare in patients who stopped glucocorticoids regarding age: (A) WMD for continuous measurement; (B) HR for dichotomous measurement.
Figure 3
Figure 3
Forest plots of the OR for the risk of flare in patients who stopped glucocorticoids regarding gender.
Figure 4
Figure 4
Forest plots of the OR for the risk of flare in patients who stopped glucocorticoids regarding serologically active clinically quiescent.
Figure 5
Figure 5
Forest plots of the OR for the risk of flare in patients who stopped glucocorticoids regarding concomitant treatment: (A) hydroxychloroquine; (B) immunosuppressant.
See this image and copyright information in PMC

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