SLE Medication Tapering Order — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModerateRheumatologySLE Medication Tapering OrderRACP Adult Medicine

A 45-year-old woman with SLE on hydroxychloroquine, mycophenolate, and low-dose prednisolone has been in clinical remission for 2 years. Her anti-dsDNA has normalised and complement levels are normal. She asks about tapering immunosuppression. What is the safest medication to taper first?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — All three simultaneously

In SLE remission, prednisolone should be the first medication tapered (and ideally ceased) due to its significant cumulative toxicity (osteoporosis, diabetes, cataracts, AVN, infections, cardiovascular disease). Tapering should be gradual (1 mg/month or slower once below 7.5 mg). Hydroxychloroquine should be the LAST medication reduced/ceased – it reduces flares, organ damage, thrombosis, and improves survival in SLE. Cessation of HCQ is associated with a 2.5× increased flare risk. Mycophenolate maintenance is typically continued for ≥5 years (or longer) before considering reduction.

Reference: eTG – 2025 – Rheumatology; EULAR – 2023 – SLE Treatment Recommendations