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Multicenter Study
. 2025 Sep 1;64(9):5014-5022.
doi: 10.1093/rheumatology/keaf243.

Impact of glucocorticoid tapering speed on renal outcomes in proliferative lupus nephritis: a multicentre retrospective study

Koichiro Ohmura  1 , Hayato Shimizu  1   2 , Yoshiya Tanaka  3 , Keiju Hiromura  4 , Hiroki Hayashi  5 , Kazuro Kamada  6 , Kentaro Minowa  7 , Yutaka Kawahito  8 , Akiho Iwashita  9 , Shinya Kaname  10   11 , Shinsuke Yasuda  12 , Kazuoto Hiramoto  13 , Shoichi Maruyama  14 , Nobuyuki Yajima  15 , Yasunori Iwata  16 , Isao Matsumoto  17 , Takahisa Gono  18   19 , Hiroko Sato  20 , Satoshi Kubo  3 , Singo Nakayamada  3 , Hidekazu Ikeuchi  4 , Yukio Yuzawa  5 , Michihito Kono  6 , Naoto Tamura  7 , Takahiro Seno  8 , Takashi Kida  8 , Aki Sakashita  8 , Akira Onishi  21 , Akio Morinobu  9 , Takahisa Kawakami  10 , Tadashi Hosoya  12 , Taiki Yamaguchi  12 , Yuko Kaneko  13 , Hironari Hanaoka  13 , Sawako Kato  14 , Kayaho Maeda  14 , Shiori Nakagawa  16 , Yuya Kondo  17 , Masataka Kuwana  18   19 , Tomonori Ishii  20   22 , Shuji Sumitomo  1 , Chisato Miyakoshi  23 , Tatsuya Atsumi  6
Affiliations
Multicenter Study

Impact of glucocorticoid tapering speed on renal outcomes in proliferative lupus nephritis: a multicentre retrospective study

Koichiro Ohmura et al. Rheumatology (Oxford). .

Abstract

Objectives: Recent guidelines and recommendations for LN suggest rapid glucocorticoid (GC) reduction; however, robust supporting evidence remains limited. This study aimed to evaluate the impact of rapid GC reduction on renal outcomes in patients with proliferative LN.

Methods: We conducted a multicentre retrospective chart review of patients with GC-naïve, biopsy-proven proliferative LN with available urinary protein-to-creatinine ratio (UPCR) data before and 52 weeks after GC treatment. Patients who reduced their prednisolone-equivalent dose to ≤7.5 mg/day within 6 months (rapid GC reducers) were compared with those who did not (conventional GC reducers) regarding partial renal response (PRR) at 12 months. Modified Poisson regression analysis was used to adjust for confounding factors.

Results: A total of 344 patients from 17 centres were included: 50 rapid GC reducers and 294 conventional GC reducers. PRR at 12 months was achieved by 43/50 (86%) in the rapid GC group and 248/294 (84.4%) in the conventional group. After adjusting for age, initial UPCR, initial estimated glomerular filtration rate, the presence of a concomitant membranous lesion in the glomerulus, initial GC dose, use of methylprednisolone pulse therapy, strong immunosuppressants (mycophenolate mofetil, cyclophosphamide or rituximab) and hydroxychloroquine, no significant difference was observed in PRR at 12 months (adjusted risk ratio: 0.92, P = 0.758). Relapse rates and serious adverse events over 2 years of follow-up were also comparable between the groups.

Conclusion: Rapid GC reduction to ≤7.5 mg/day within 6 months did not compromise renal outcomes or increase relapse in proliferative LN.

Keywords: LN; SLE; glucocorticoid; relapse; renal outcome; speed; tapering; treatment.

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