#2-29E. Tapering GC in Proliferative Lupus Nephritis: How Fast is Safe? (RHEUM, 2025)

How quickly can we safely taper glucocorticoids (GCs) in patients with active lupus nephritis (LN) while sustaining renal response and minimizing long-term GC toxicity? This multicentre retrospective study addresses this crucial clinical dilemma by analyzing 344 GC-naïve patients with biopsy-proven proliferative LN (Class III/IV). The researchers compared renal outcomes between "rapid GC reducers" (achieving PSL ≤7.5 mg/day within 6 months, n=50) and "conventional GC reducers" (n=294). The key finding is that rapid GC reduction did not significantly compromise the primary endpoint of Partial Renal Response (PRR) at 12 months, nor the Complete Renal Response (CRR) rates or 2-year relapse rates, showing comparable efficacy to slower tapering strategies. This robust finding supports minimizing GC exposure, consistent with current guidelines6. However, physicians must critically note the inherent bias of the retrospective design and the fact that the rapid reduction group utilized strong immunosuppressants and hydroxychloroquine significantly more often, suggesting potential confounding factors influenced treatment decisions and outcomes. Nevertheless, this study provides timely, real-world evidence for rheumatologists and nephrologists, strongly suggesting that early, rapid GC tapering is a viable and effective strategy for managing proliferative LN.

Citation: Ohmura K., Shimizu H., Tanaka Y. et al. Impact of glucocorticoid tapering speed on renal outcomes in proliferative lupus nephritis: a multicentre retrospective study. Rheumatology. 64(9), 5014–5022, 2025. DOI: 10.1093/rheumatology/keaf243

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