{
  "abstract": "Objectives Systemic glucocorticoid (GC) therapy is indispensable for treating active systemic lupus erythematosus (SLE) and lupus nephritis (LN). However, GC can cause significant comorbidities and irreversible organ damage. The judicious, limited use of GC while effectively managing disease activity represents a critical yet unresolved challenge. This study aimed to formulate pragmatic recommendations for GC use in SLE.Methods Following established consensus guideline procedures, the Taiwan College of Rheumatology (TCR) SLE Special Interest Group (SLE-SIG) developed recommendations through a systematic literature review and a formal Delphi process. The review identified core topics and drafted preliminary statements addressing: (1) general GC usage, tapering, and treatment targets; (2) organ-specific dosing strategies; and (3) special conditions such as SLE with antiphospholipid syndrome (SLE-APS), pulmonary arterial hypertension (SLE-PAH), and pregnancy. Disease activity and severity were graded using BILAG-2004 and SLEDAI-2K. GC doses were expressed in prednisolone or methylprednisolone equivalents. Statements were voted upon in iterative Delphi rounds, with >=75% agreement required for adoption.Results A series of consensus statements encompassed 3 universal principles regarding GC use in SLE, 5 general recommendations pertaining to GC initiation, tapering, and therapeutic goals, and 11 organ-specific recommendations. The preliminary evaluation of GC regimens for active SLE involved assessing organ involvement and severity, considering comorbidities and the potential risk of complications, and evaluating concomitant medication regimens, including immunosuppressants and biologics. The initial GC dose and GC pulse therapy were determined based on this evaluation, with the tapering protocol to reach the target long-term GC dose of 5 mg/day by week 24.Organ-specific statements delineated the recommended initial GC dose and GC pulse dosages. Organ involvement was categorized as mild disease and constitutional symptoms, mucocutaneous and arthritis, LN, neuropsychiatric SLE (NPSLE), and internal organ SLE. The latter 3 categories were further stratified according to severity for LN and NPSLE, and potential life-threatening or organ-threatening disease for internal organ SLE. Statements regarding GC use in special considerations, including SLE with anti-phospholipid syndrome (SLE-APS), SLE with pulmonary arterial hypertension (SLE-PAH), and pregnancy, were also provided.Abstract PO:10:264 Table 1Conclusions These preliminary statements provide evidence-driven, consensus-based guidance on GC dosing in SLE.",
  "authors": [
    {
      "affiliations": [
        "Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, China"
      ],
      "name": "Wen-Nan Huang"
    },
    {
      "affiliations": [
        "Division of Rheumatology, Immunology, and Allergy, Tri-service General Hospital, Taipei, Taiwan, China",
        "Division of Allergy, Immunology and Rheumatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, China"
      ],
      "name": "Chun-Chi Lu"
    },
    {
      "affiliations": [
        "Division of Rheumatology, Immunology, and Allergy, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan, China"
      ],
      "name": "Tai-Ju Lee"
    },
    {
      "affiliations": [
        "Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, China"
      ],
      "name": "Heh-Shiang Sheu"
    }
  ],
  "title": "PO:10:264 Development of consensus statements on glucocorticoid use in systemic lupus erythematosus",
  "uid": "d05d1b10-d348-5848-aba9-459c463e939a"
}