Impact of glucocorticoid tapering speed on renal outcomes in proliferative lupus nephritis: a multicentre retrospective study

Abstract Objectives Recent guidelines and recommendations for lupus nephritis (LN) suggest rapid glucocorticoid (GC) reduction; however, robust supporting evidence remains limited. This study aimed to evaluate the impact of rapid GC reduction on renal outcomes in patients with proliferative LN. Methods We conducted a multicentre retrospective chart review of patients with GC-naïve, biopsy-proven proliferative LN with available urinary protein-to-creatinine ratio (UPCR) data before and 52 weeks after GC treatment. Patients who reduced their prednisolone-equivalent dose to ≤ 7.5 mg/day within 6 months (rapid GC reducers) were compared with those who did not (conventional GC reducers) regarding partial renal response (PRR) at 12 months. Modified Poisson regression analysis was used to adjust for confounding factors. Results A total of 344 patients from 17 centres were included: 50 rapid GC reducers and 294 conventional GC reducers. PRR at 12 months was achieved by 43/50 (86%) in the rapid GC group and 248/294 (84.4%) in the conventional group. After adjusting for age, initial UPCR, initial estimated glomerular filtration rate, the presence of a concomitant membranous lesion in the glomerulus, initial GC dose, use of methylprednisolone pulse therapy, strong immunosuppressants (mycophenolate mofetil, cyclophosphamide, or rituximab), and hydroxychloroquine, no significant difference was observed in PRR at 12 months (adjusted risk ratio: 0.92, p= 0.758). Relapse rates and serious adverse events over 2 years of follow-up were also comparable between the groups. Conclusion Rapid GC reduction to ≤ 7.5 mg/day within 6 months did not compromise renal outcomes or increase relapse in proliferative LN.