Featured Research

from universities, journals, and other organizations

New guidance on how and when to stop immunosuppressants in lupus patients

Date:
June 11, 2014
Source:
European League Against Rheumatism
Summary:
A new study showed that, for the majority of lupus patients who are in remission, it is possible to successfully stop immunosuppressant therapy without triggering a flare of their disease. Within two years, it was possible to stop the immunosuppressant in about 70 percent of clinically stable patients. Half were successful within three years, and this proportion remained stable for up to five years.

A new study presented today at the European League Against Rheumatism Annual Congress (EULAR 2014) showed that, for the majority of lupus patients who are in remission, it is possible to successfully stop immunosuppressant therapy without triggering a flare of their disease.1 Within two years, it was possible to stop the immunosuppressant in about 70% of clinically stable patients. Half were successful within three years, and this proportion remained stable for up to five years.1

Lupus is a chronic inflammatory disease that can affect any organ system, but mainly involves the joints, kidneys and skin.2 It typically follows a relapsing and remitting course; during a relapse, patients feel fatigue, and may develop rashes, arthritis (painful and swollen joints) and fever.2 Being able to stop long-term immunosuppressant therapy in a lupus patient without inducing a relapse is an important treatment goal because of the potential side effects of these drugs, including the increased risk of infection and cancer.

In the USA, the average incidence of SLE has been estimated to range between 1.8 and 7.6 cases per 100,000 person-years.3 Incidence rates in Europe are similar, ranging from 3.3 to 4.8 per 100,000 person-years. The incidence of SLE is greater in Afro-Americans compared with Caucasians.4 SLE affects 10 times as many women as men.2

Lupus patients who develop serious or life-threatening problems such as kidney inflammation, lung or heart involvement, and central nervous system symptoms need more aggressive treatment, including high-dose corticosteroids such as prednisone, and immunosuppressants such as azathioprine (AZA), methotrexate (MTX) and mycophenolate mofetil (MMF).

"Until now, information on whether and how immunosuppressant therapy might be stopped in lupus patients after achieving low disease activity or remission has been limited," said lead author Dr Zahi Touma, Assistant Professor of Medicine, Clinician-Scientist, Division Of Rheumatology, University of Toronto, Canada.

"The results from our study provide useful guidance on how best to stop the immunosuppressant without triggering a flare. For example, patients who discontinued their immunosuppressant more slowly were less likely to flare within two years," Dr Touma explained. "Those lupus patients who were serologically active at the time the immunosuppressant was stopped were much more likely to flare on follow-up visits," he added.

Out of a total population of 1,678 patients registered at the Toronto Lupus Clinic, 973 had been prescribed an immunosuppressant; and 99 had stopped taking it, of which 56 had been on AZA, 25 on MTX, and 18 on MMF. Of the 99 patients who stopped their immunosuppressant, 25 flared within two years (16 on AZA; 7 on MTX and 2 on MMF; p=0.31); 17 patients experienced a flared after year two.

Comparing patients who flared within two years to those who did not, the percentage of patients with positive serology† at the time their immunosuppressant was stopped was greater in those who flared, 68% vs. 42% (p=0.04).

In the no flare group, the length of time from the start of tapering to stopping the immunosuppressant was 1.81.8 years, significantly slower than the 0.90.9 years in the group who did experience a flare (p=0.002).

At the start of tapering, the mean age of the patients was 40.413.1 and mean disease duration was 11.49.4 years. 46 of the patients had follow-up available beyond two years; 32 were followed beyond three years, 26 beyond four years and 24 beyond five years. Using a Kaplan-Meier curve for the time to flare, at one, two, three, four and five years, the percentage of patients who flared was 17%, 30%, 46%, 49% and 51% respectively.

The analysis for this study was conducted on all patients seen in the Toronto Lupus Clinic in whom an immunosuppressant was tapered and then stopped. To be included, the lupus patient had to be in clinical remission: defined as no activity in the clinical SLE Disease Activity Index-2000 (SLEDAI-2K) descriptors‡ and an absence of proteinuria or lupus-related thrombocytopenia and leukopenia, and also to be taking ≤7.5mg of prednisone per day.

Three time points were identified for each patient:

  • the start of tapering defined as the first visit with a decrease of at least 25% in the dose of immunosuppressant
  • the day the immunosuppressant was completely stopped
  • the end of the study -- defined as the date of flare, or last clinic visit after the immunosuppressant was stopped.

Flare was defined as the introduction of a new immunosuppressant, or any increase of prednisone dosage in the context of clinically active lupus.

Flare was evaluated within the first two years from the immunosuppressant being stopped, and also at any time after the immunosuppressant was stopped.


Story Source:

The above story is based on materials provided by European League Against Rheumatism. Note: Materials may be edited for content and length.


Cite This Page:

European League Against Rheumatism. "New guidance on how and when to stop immunosuppressants in lupus patients." ScienceDaily. ScienceDaily, 11 June 2014. <www.sciencedaily.com/releases/2014/06/140611093629.htm>.
European League Against Rheumatism. (2014, June 11). New guidance on how and when to stop immunosuppressants in lupus patients. ScienceDaily. Retrieved September 17, 2014 from www.sciencedaily.com/releases/2014/06/140611093629.htm
European League Against Rheumatism. "New guidance on how and when to stop immunosuppressants in lupus patients." ScienceDaily. www.sciencedaily.com/releases/2014/06/140611093629.htm (accessed September 17, 2014).

Share This



More Health & Medicine News

Wednesday, September 17, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

President To Send 3,000 Military Personnel To Fight Ebola

President To Send 3,000 Military Personnel To Fight Ebola

Newsy (Sep. 16, 2014) President Obama is expected to send 3,000 troops to West Africa as part of the effort to contain Ebola's spread. Video provided by Newsy
Powered by NewsLook.com
Obama Orders Military Response to Ebola

Obama Orders Military Response to Ebola

AP (Sep. 16, 2014) Calling the Ebola outbreak in West Africa a potential threat to global security, President Barack Obama is ordering 3,000 U.S. military personnel to the stricken region amid worries that the outbreak is spiraling out of control. (Sept. 16) Video provided by AP
Powered by NewsLook.com
UN: 20,000 Could Be Infected With Ebola by Year End

UN: 20,000 Could Be Infected With Ebola by Year End

AFP (Sep. 16, 2014) Nearly $1.0 billion dollars is needed to fight the Ebola outbreak raging in west Africa, the United Nations say, warning that 20,000 could be infected by year end. Duration: 00:40 Video provided by AFP
Powered by NewsLook.com
Obama: Ebola Outbreak Threat to Global Security

Obama: Ebola Outbreak Threat to Global Security

AP (Sep. 16, 2014) President Obama is ordering U.S. military personnel to West Africa to deal with the Ebola outbreak, which is he calls a potential threat to global security. (Sept. 16) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

    Technology News



    Save/Print:
    Share:

    Free Subscriptions


    Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

    Get Social & Mobile


    Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

    Have Feedback?


    Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
    Mobile: iPhone Android Web
    Follow: Facebook Twitter Google+
    Subscribe: RSS Feeds Email Newsletters
    Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins