Low-dose glucocorticoids in SLE

New evidence around use and thresholds in SLE

2024-06-13

(Press-News.org) In a session on diagnosing and managing complex diseases at the 2024 EULAR congress in Vienna, two abstracts tackled this issue.

First, Filippo Vesentini presented on the risk of flare with glucocorticoid compared to low-dose maintenance – based on a retrospective analysis of prospectively collected data from people with SLE. Flare-free remission and predictors of such were evaluated respectively in remitted patients on and off glucocorticoids.

During follow-up, 484 patients achieved remission at least once during follow-up – 360 patients of these discontinued glucocorticoids, while 124 remained on a dose of 5 mg per day or less. There were subsequently 85 flares over a mean period of 87 months. Of these, 48 were in those who had discontinued glucocorticoids, and 37 in those remaining on a low dose – equivalent to an annual flare rate of 8.5 and 1.65 flares per 100 patients/year respectively. Disease duration and anti-U1RNP were positive and negative predictors of flare-free remission, respectively. The group conclude that glucocorticoid discontinuation after proper tapering is safe and associated with a low risk of flare.

A second presentation from Eric Morand explored whether lowering the glucocorticoid ceiling in the definition of LLDAS – to be in line with the 5 mg EULAR recommendations – (LLDAS-5) was associated with improved protection from flare, irreversible organ damage accrual, and mortality when compared with the original 7.5 mg definition (LLDAS-7.5).

Data were analysed from a longitudinal SLE cohort of 2,213 patients. Of these, 2.1% died, 29% accrued organ damage, and 67% experienced flares. LLDAS-7.5 was achieved by 87% of patients in 47% of visits, whereas 83% of patients attained LLDAS-5 in 42% of visits, with considerable and predicted overlap. The magnitude of protection provided by LLDAS attainment against mortality, irreversible organ damage accrual, or flare was similar with both glucocorticoid dose thresholds.

These findings support the idea that while lowering glucocorticoid dose remains a key goal of management for people with SLE, there was no evidence to support revising the dose threshold of the LLDAS definition, and therefore the validated definition should continue to be used in both clinical studies and everyday patient care.

Source

Vesentini F, et al. Glucocorticoid withdrawal does not increase the risk of flares during remission in Systemic Lupus Erythematosus. Presented at EULAR 2024; OP0180.

Ann Rheum Dis 2024; DOI: 10.1136/annrheumdis-2024-eular.5032.

Kandane-Rathnayake R, et al. Impact of glucocorticoid dose threshold in definition of Lupus Low Disease Activity State. Presented at EULAR 2024; OP0124.

Ann Rheum Dis 2024; DOI: 10.1136/annrheumdis-2024-eular.2742.

References

1. Fanouriakis A, et al. EULAR recommendations for the management of systemic lupus erythematosus: 2023 update. Ann Rheum Dis 2024;83(1):15–29.

2. Golder V, et al. Lupus low disease activity state as a treatment endpoint for systemic lupus erythematosus: a prospective validation study. Lancet Rheumatol 2019;1(2):e95–102.

About EULAR

EULAR is the European umbrella organisation representing scientific societies, health professional associations and organisations for people with rheumatic and musculoskeletal diseases (RMDs). EULAR aims to reduce the impact of RMDs on individuals and society, as well as improve RMD treatments, prevention, and rehabilitation. To this end, EULAR fosters excellence in rheumatology education and research, promotes the translation of research advances into daily care, and advocates for the recognition of the needs of those living with RMDs by EU institutions.

Contact

EULAR Communications, communications@eular.org

Notes to Editors

EULAR Recommendations

EULAR School of Rheumatology

EULAR Press Releases

END

ELSE PRESS RELEASES FROM THIS DATE:

Implementing physical activity recommendations

2024-06-13

An HPR abstract sessions at the 2024 EULAR congress looked specifically at harnessing the benefits of exercise in rheumatic and musculoskeletal diseases (RMD) – and the challenges to their practical implementation. Mohamed Saadi presented a systematic review examining barriers and facilitators affecting adherence to EULAR’s physical activity recommendations. Across 68 selected articles, 29 different themes were identified – 9 of which were social, 16 environmental, and 4 systemic. The five most frequently found themes were having supportive family and friends, a supportive health professional, followed by costs, and access or proximity to adapted and ...

Achieving drug-free remission in AXSPA

2024-06-13

Even though early therapeutic interventions have proven successful in inducing drug-free remission in other inflammatory rheumatic diseases, such studies remain difficult to conduct in axial spondyloarthritis (axSpA), which manifests itself by insidious onset inflammatory back pain. As a result it is often diagnosed late,5 and a consensus definition of early disease was only recently published.6 At the 2024 EULAR congress, Łukasik and colleagues shared data from their prospective study evaluating the efficacy of a ...

Unpicking the pathogenesis of RA

2024-06-13

Rheumatoid arthritis (RA) is an autoimmune disease that causes joint inflammation and destruction.1 There is currently no cure – and although there are many treatments, their effectiveness varies from person to person, suggesting an undefined pathogenic diversity.1 Deep characterisation of myeloid cell subsets by single cell RNA sequencing across healthy and inflamed tissues in RA has led to the identification of new pathogenic cell states and subsets – with data coming from five large-scale studies.1-5 But subset overlap across studies and compartments – such as in blood versus synovial tissue – has not yet ...

Kids First DRC launches enhanced data portal to strengthen collaborative pediatric research

2024-06-13

The Gabriella Miller Kids First Data Resource Center (Kids First DRC) announces the release of an upgraded Kids First Data Resource Portal, designed to streamline big data search and data analysis. Accessible at portal.kidsfirstdrc.org, the new portal represents a significant advancement in data accessibility, user experience, and collaborative potential with researchers, families, and patients. Elevated User Experience Introducing several key enhancements, the new Kids First DRC Portal prioritizes user-centric ...

Neural balance in the brain is associated with brain maturity and better cognitive ability

2024-06-13

In a world where external and internal stimuli can throw our entire body system off balance, how does our brain prevent itself from becoming overly stimulated? The answer lies in our brain’s ability to maintain the balance of neural excitation (E) and inhibition (I), known as the E/I ratio. By regulating the E/I ratio, the brain prevents over-stimulation and under-stimulation. The E/I ratio of children decreases with healthy development. Children with a lower E/I ratio were observed to have better performance than their peers in cognitive tests such as memory and intelligence, according to studies by researchers from the Centre for Sleep and Cognition ...

Parliamentary members use simpler language on hot days

2024-06-13

Climate change has many widespread and complicated effects on the well-being of people and the planet, and a new study in iScience on June 13 has now added a surprising one to the list. After analyzing the language used in seven million parliamentary speeches around the world, it shows that high temperatures lead to a significant and immediate reduction in politicians’ language complexity. The results suggest that rising heat may come with impacts on our cognitive abilities with real and immediate consequences, the researchers say. The study also showcases ...

Food: Greater gender equality associated with men eating meat more frequently than women

2024-06-13

Men tend to eat meat more frequently than women and the extent of the differences in meat consumption frequency between both genders tend to be greater within countries with higher levels of gender equality and social and economic development, according to a study published in Scientific Reports. The authors suggest that this could be due individuals within these countries having greater opportunities to express food preferences. Christopher Hopwood and colleagues investigated differences in meat consumption between men and women across countries with differing levels of social ...

Antipsychotic medications don’t just stop working below the neck

2024-06-13

PITTSBURGH, June 13, 2024 – New University of Pittsburgh research points to a potential approach to reducing the risk of diabetes associated with widely prescribed antipsychotic medications. The study presents early evidence in support of co-administering antipsychotic medications that block dopamine receptors in the brain alongside drugs that stop antipsychotics from blocking those same receptors in the pancreas. This approach, published today in Diabetes, could limit metabolic side effects, including impaired control over blood sugar, or dysglycemia. This research may also explain why weight control medications, including new neuropeptide drugs Wegovy and Ozempic, may not ...

New study: Outdoor recreation noise affects wildlife behavior and habitat use

2024-06-13

FORT COLLINS, Colo., June 13, 2024 — We may go to the woods seeking peace and quiet, but are we taking our noise with us? A recent study published in the journal, Current Biology, led by scientists from the USDA Forest Service Rocky Mountain Research Station indicates that the answer is yes—and that this noise can trigger a fear response, as if escaping from predators. This new science calls into question whether otherwise high-quality habitat truly provides refugia for wildlife when recreationists are present and underscores the challenges land managers face in balancing ...

Confronting trauma alleviates chronic pain among older veterans

2024-06-13

A new study led by UCLA Health and the U.S. Veterans Affairs Office found chronic pain among older adults could be significantly reduced through a newly developed psychotherapy that works by confronting past trauma and stress-related emotions that can exacerbate pain symptoms. Published in JAMA Network Open on June 13, the study compared the newer therapy, known as emotional awareness and expression therapy, or EAET, to traditional cognitive behavioral therapy, or CBT, in treating chronic pain as well as mental health symptoms such as depression, anxiety and post-traumatic stress disorder symptoms among older veterans. The ...

Low-dose glucocorticoids in SLE

ELSE PRESS RELEASES FROM THIS DATE:

LAST 30 PRESS RELEASES: