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Glucocorticoids in Maintenance of Systemic Lupus Erythematosus: Is Complete Withdrawal a Possibility?

Nupoor Acharya *

Systemic lupus erythematosus [SLE] is a potentially life-threatening disease and the treatment consists of immunosuppression. Glucocorticoids have played a major role in remission induction and maintenance in SLE for a very long time. Prolonged use of glucocorticoids leads to vast array of steroid related adverse effects. Also, steroid use is associated with increased damage accrual in SLE as seen in various studies. This effect can be mitigated by using minimum doses of glucocorticoids, for shortest periods. However, lack of clear guidelines on steroid dose and duration, leads to variations in clinical practice. The paucity of randomized controlled trials and alternative drugs, make the withdrawal of steroids in SLE difficult. This review discusses the various studies addressing steroid tapering and withdrawal, and areas of future research. Longer duration of remission before attempting withdrawal, and use of additional immunosuppression might be the key to successful withdrawal