Clinical Rheumatology

, Volume 38, Issue 4, pp 1089–1097 | Cite as

Steroid-free remission in lupus: myth or reality; an observational study from a tertiary referral centre

  • Rudra Prosad Goswami
  • Hiramanik Sit
  • Parasar GhoshEmail author
  • Geetabali Sircar
  • Alakendu Ghosh
Original Article



Whether maintaining steroid-free remission is feasible in Indian patients with systemic lupus erythematosus (SLE).


In 148 patients with SLE including 78 lupus nephritis (LN) previously put into remission, steroid therapy was gradually tapered off.


Patients received glucocorticoids for median 1855 days (interquartile range (IQR) 901–2834) before discontinuing. Median duration of follow-up was 539 days (IQR 266.25–840.75). Flare occurred in 31 patients (20.9%; 95% confidence interval (CI) 15.17–28.19, renal flare in 12.16% (18/148, 95% CI 7.83–18.41)). Most of the flares occurred in the first year of follow-up (41.9%, 13/31). Overall 93.5% (29/31) of flares occurred in those who received ≤ 8 years of glucocorticoids, compared to 6.5% (2/31) of flares in others (p = 0.009). Median flare-free survival was 611 days (95% CI 518–704). Multivariate Cox regression identified the following predictors of flare-free survival: duration of disease (hazard ratio (HR) 0.89, 95% CI 0.84–0.94, p < 0.001), duration of glucocorticoid before discontinuing (HR 1.000086, 95% CI 1.000047–1.00012, p < 0.001) and second immunosuppressive (HR 1.89, 95% CI 1.251–2.87, p = 0.003). Additional risk factors of a renal flare-free survival among patients with LN were initial dose of glucocorticoids (HR 0.97, 95% CI 0.94–0.99, p = 0.005) and presence of haemolytic anaemia (HR 2.43, 95% CI 1.067–5.54, p = 0.035).


About 20% patients undergo exacerbation of disease activity after glucocorticoid withdrawal. Treatment for ≥ 8 years before discontinuing and an additional immunosuppressive agent improve the chance of flare-free survival.


Flare-free survival Glucocorticoid Lupus nephritis Steroid-free-remission Systemic lupus erythematosus 


Compliance with ethical standards



Supplementary material

10067_2018_4377_MOESM1_ESM.doc (75 kb)
ESM 1 (DOC 75 kb)


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Copyright information

© International League of Associations for Rheumatology (ILAR) 2018

Authors and Affiliations

  • Rudra Prosad Goswami
    • 1
  • Hiramanik Sit
    • 1
  • Parasar Ghosh
    • 1
    Email author
  • Geetabali Sircar
    • 1
  • Alakendu Ghosh
    • 1
  1. 1.Department of RheumatologyInstitute of Post Graduate Medical Education and ResearchKolkataIndia

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