An era of immunosuppressant withdrawal in systemic lupus erythematosus: winning through weaning

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease involving flares interspersed with phases of remission. Clinical presentations are heterogeneous, with some patients developing severe organ involvement, particularly in the kidneys, which can lead to chronic kidney disease and kidney failure. Continuous research efforts are being made to improve the short-term and long-term efficacy of SLE treatments, with the aim of obtaining remission and preventing subsequent flares to limit the risk of organ damage. Thus, long-term immunosuppressive therapies are often proposed to patients with severe lupus nephritis. 1 Fanouriakis A Kostopoulou M Andersen J et al. EULAR recommendations for the management of systemic lupus erythematosus: 2023 update. Ann Rheum Dis. 2023; 83: 15-29 Crossref Scopus (8) Google Scholar There are multiple drawbacks to this strategy. Two main problems are the burden placed on patients to take a treatment for a prolonged or even indefinite period which can discourage compliance, 2 Costedoat-Chalumeau N Houssiau FA Improving medication adherence in patients with lupus nephritis. Kidney Int. 2021; 99: 285-287 Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar which in turn can lead to relapses; and second, the risk of treatment-related adverse events, especially infections, which are a major cause of mortality in patients with SLE. 3 Thomas G Mancini J Jourde-Chiche N et al. Mortality associated with systemic lupus erythematosus in France assessed by multiple-cause-of-death analysis. Arthritis Rheumatol. 2014; 66: 2503-2511 Crossref PubMed Scopus (144) Google Scholar Mycophenolate mofetil withdrawal in patients with systemic lupus erythematosus: a multicentre, open-label, randomised controlled trialMycophenolate mofetil is an immunosuppressant commonly used to treat systemic lupus erythematosus (SLE) and lupus nephritis. It is a known teratogen associated with significant toxicities, including an increased risk of infections and malignancies. Mycophenolate mofetil withdrawal is desirable once disease quiescence is reached, but the timing of when to do so and whether it provides a benefit has not been well-studied. We aimed to determine the effects of mycophenolate mofetil withdrawal on the risk of clinically significant disease reactivation in patients with quiescent SLE on long-term mycophenolate mofetil therapy. Full-Text PDF