{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T05:28:10Z","timestamp":1788672490319,"version":"build-2803163510"},"reference-count":54,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T00:00:00Z","timestamp":1760918400000},"content-version":"unspecified","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2025,9,24]]},"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The optimal duration of glucocorticoid (GC) treatment in lupus nephritis (LN) remains unclear. We examined predictors of GC tapering and discontinuation (D\/C), flares during tapering and post-D\/C and long-term outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed inception cohort data (1992\u20132021) from 136 patients with LN (median follow-up: 121 months) and applied regression models to assess predictors of successful GC D\/C and long-term outcomes, including clinical\/laboratory, histological and treatment characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Median time to 7.5\u2009mg\/day, 5\u2009mg\/day and GC D\/C was 9, 12 and 29 months post-diagnosis, respectively. Composite complete renal response (CR) and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)-2K\u22644, sustainedly attained until GC D\/C (HR: 1.85, p=0.016), membranous LN (HR: 1.81, p=0.01) and persistent use of hydroxychloroquine (HR: 1.49, p=0.04) were associated with a shorter time to GC D\/C. Patients diagnosed after 2010 achieved earlier GC D\/C.<\/jats:p>\n                    <jats:p>Shorter time to CR (OR: 1.05, p=0.034) and Lupus Low Disease Activity State at tapering from 7.5\u2009mg\/day onwards (OR: 0.23, p=0.046) reduced flare risk during tapering. Definition Of Remission In Systemic Lupus Erythematosus (DORIS) complete remission at D\/C (OR: 0.20, p=0.005) and persistent hydroxychloroquine use (OR: 0.28, p=0.031) protected against post-D\/C renal flares. Neither higher initial GC dose (&gt;40\u2009mg\/day) nor slower GC tapering prevented renal flares. Time to GC D\/C (OR: 1.02\/month, p=0.04) and flares (OR: 2.08, p=0.036) were associated with damage risk at the end of follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Sustained CR\/SLEDAI-2K\u22644, membranous LN and persistent hydroxychloroquine use emerged as main predictors of shorter time to D\/C, while DORIS complete remission at D\/C and persistent hydroxychloroquine use predicted post-DC flares. Time to GC D\/C and flares independently contributed to 10-year damage accrual.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rmdopen-2025-005877","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T07:55:20Z","timestamp":1761033320000},"page":"e005877","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Predictors of a successful glucocorticoid tapering and withdrawal in an inception cohort of patients with lupus nephritis and associations with long-term outcomes and damage accrual"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3314-3329","authenticated-orcid":false,"given":"Ioannis E","family":"Michelakis","sequence":"first","affiliation":[{"name":"First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, Laiko Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandros","family":"Panagiotopoulos","sequence":"additional","affiliation":[{"name":"First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, Laiko Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleni","family":"Kapsia","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Renal Transplantation, Laiko Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Boletis","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Renal Transplantation, Laiko Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Smaragdi","family":"Marinaki","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Renal Transplantation, Laiko Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petros P","family":"Sfikakis","sequence":"additional","affiliation":[{"name":"First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, Laiko Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2238-0975","authenticated-orcid":false,"given":"Maria G","family":"Tektonidou","sequence":"additional","affiliation":[{"name":"First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, Laiko Hospital, National and Kapodistrian University of 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