Stopping Immunosuppressants without Flare Trigger in Lupus Patients
New research showed that it is possible to successfully stop immunosuppressant therapy without triggering a flare for the majority of lupus patients in remission, as presented at the European League Against Rheumatism Annual Congress (EULAR 2014).
Immunosuppressant therapy (eg, azathioprine, methotrexate, and mycophenolate mofetil) is started in patients who require more aggressive treatment due to serious or life-threatening symptoms such as kidney inflammation, lung/heart involvement, and central nervous system symptoms.
In the study, it was possible to stop immunosuppressant use within 2 years in about 70% of clinically stable patients, and about half were successful within 3 years. This proportion remained steady for up to 5 years. A total of 1,678 patients were registered at the Toronto Lupus Clinic, of which 973 had been prescribed an immunosuppressant. Of the 973 patients, 99 had stopped taking it, and 25 of those patients experienced a flare within 2 years; 17 of those patients experienced a flare after 2 years.
Flare was assessed within the first 2 years from the immunosuppressant being stopped, and also at any point after the immunosuppressant was stopped.
In the no flare group, the length of time from the start of tapering to stopping the immunosuppressant was 1.8±1.8 years, which was significantly slower than the 0.9±0.9 years in the group who did experience a flare (P=0.002). Also, the percentage of patients with positive serology at the time their immunosuppressant was stopped was greater in those who flared than those who did not, 68% vs. 42% (P=0.04).
For more information visit EULAR.org.