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SLE Treatment De-escalation — SCE Rheumatology MCQ

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ModerateSLE & Antiphospholipid SyndromeSLE Treatment De-escalationSCE Rheumatology

A 48-year-old woman with SLE is in sustained DORIS remission on therapy (clinical SLEDAI-2K 0 Prednisolone 4 mg daily stable immunosuppression). Her rheumatologist considers whether to further taper treatment. According to EULAR 2023 what is the recommended approach?

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Correct answer: C — Gradually taper glucocorticoids to withdrawal if possible while maintaining Hydroxychloroquine and carefully reducing immunosuppression over years with close monitoring

EULAR 2023 recommends gradual treatment de-escalation in sustained remission: glucocorticoids should be tapered and ideally withdrawn first while maintaining Hydroxychloroquine (which should be continued indefinitely or for as long as possible). Immunosuppressive drugs can be cautiously reduced after sustained remission (months to years) with close monitoring of serological markers and clinical status. Treatment withdrawal should be sequential and slow. Flare risk increases with each drug withdrawal. Hydroxychloroquine should be the last agent reduced given its protective effects on multiple SLE outcomes and low toxicity profile.

Reference: EULAR 2023 SLE recommendations; van Vollenhoven RF et al 2021 DORIS remission framework