Half of Lupus Patients Can Safely Taper Immunosuppressants. Here's How

June 12, 2014

(EULAR 2014) Patients at a Toronto lupus clinic stopped immunosuppressants most successfully when they waited for serology to be negative and then tapered slowly.

Most patients in remission from systemic lupus erythematosus can safely stop immunosuppressants after about two years, without causing flares, according to new research from Toronto. The study has identified two factors that weigh in favor of success: not starting the process for patients who are serologically active, and tapering slowly (over a mean of about 22 months rather than half that). 

In the study from the lupus clinic at the University of Toronto, 75% of clinically stable patients were able to discontinue immunosuppressants after two years without a flare. Half of those followed for three years had discontinued the drugs without a flare, a proportion that remained stable for five years.

Until now, says lead author Zahi Touma MD, there has been only limited information about stopping medication in lupus.[[{"type":"media","view_mode":"media_crop","fid":"25141","attributes":{"alt":"","class":"media-image","height":"254","id":"media_crop_887652683685","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"2253","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","title":" ","typeof":"foaf:Image","width":"413"}}]]

To be included, patients had to be taking no more than 7.5 mg of prednisone per day and to be in clinical remission, defined as no activity in the clinical SLE Disease Activity Index-2000 (SLEDAI-2K) with no proteinuria or lupus-related thrombocytopenia and leukopenia.

The start of tapering was defined as the first visit with a decrease of at least 25% in immunosuppressant dose, and flare was defined as the introduction of a new immunosuppressant or an increase in prednisone dosage in the presence of clinically active lupus.

The study results were presented at the 2014 annual meeting of the European Union League Against Rheumatism (EULAR) in Paris.