{
  "abstract": "Objectives Lupus nephritis (LN) is one of the most common and challenging manifestations of systemic lupus erythematosus, frequently requiring prolonged immunosuppressive therapy. Achieving disease control while minimising steroid exposure remains a key treatment challenge. Understanding the factors that influence safe steroid withdrawal and identifying predictors of relapse are vital to improving patient outcomes.Aim To determine how long after treatment initiation patients with biopsy-proven LN could safely discontinue corticosteroids, to assess relapse rates following withdrawal, and to explore associations between treatment regimens, histological class, and ethnicity.Methods This retrospective study included patients under Barts Health NHS Trust Rheumatology and Renal outpatient services with biopsy-confirmed LN, seen within the past year and currently off corticosteroids. Data was extracted from clinic records, including demographics, biopsy classification, treatment regimens, duration of steroid use, and flare history.Results 59 patients were identified, 9 (15%) of which were male and 50 (85%) were female. Patient ethnicity data was recorded; Asian (40.6%), White (23.7%), Black African (15.2%), Black Caribbean (15.2%), Chinese (1.7%) or Other (3.3%). Lupus nephritis class was recorded. The mean number of months from diagnosis to cessation of corticosteroids was 82.9. The reasons cited for withdrawing corticosteroids were recorded: planned wean (88%), corticosteroid induced complications (11%) and patient self-wean (4.7%).In total, 5 patients had a relapse of LN post cessation of corticosteroid therapy, with subsequent escalation of IS therapy. Their SLEDAI scores at time of cessation of corticosteroids was 4 (compared to 1.55 in the non-relapse group). The LN class was V (60%), class V (20%) and class III/V (20%). Compliance to corticosteroids was a factor in this subgroup. Despite this, renal function in these patients remained stable; eGFR (+9.4%) and proteinuria (+18.1%).Conclusions Most patients withdrawn from prednisolone did not experience a LN flare. SLEDAI scores were higher in the flare group at time of cessation of steroids, implying that timing of steroid withdrawal was not opportune, often due to steroid non-compliance. Despite the fact that LN Class III & IV are considered to be the most severe forms of LN with the worst renal outcomes, this study indicates that safe weaning of corticosteroids is possible.",
  "authors": [
    {
      "affiliations": [
        "Barts Health Trust, London, UK"
      ],
      "name": "Evie Watts"
    },
    {
      "affiliations": [
        "Barts Health Trust, London, UK"
      ],
      "name": "Rania Ali"
    },
    {
      "affiliations": [
        "Barts Health Trust, London, UK"
      ],
      "name": "Luxme Nadarajah"
    },
    {
      "affiliations": [
        "Barts Health Trust, London, UK"
      ],
      "name": "Dev Pyne"
    },
    {
      "affiliations": [
        "Barts Health Trust, London, UK"
      ],
      "name": "Andrea Cove-Smith"
    },
    {
      "affiliations": [
        "Barts Health Trust, London, UK"
      ],
      "name": "Ravi Rajakariar"
    },
    {
      "affiliations": [
        "Barts Health Trust, London, UK"
      ],
      "name": "Angela Pakozdi"
    },
    {
      "affiliations": [
        "Barts Health Trust, London, UK"
      ],
      "name": "Sarah Mehrten"
    }
  ],
  "title": "PO:10:252 A retrospective study of biopsy-proven lupus nephritis: steroid withdrawal, treatment patterns, and ethnic variations at barts health lupus centre",
  "uid": "d06ea9c7-0f33-563f-8ec1-7e265b1ab7ff"
}