Tapering and termination of immunosuppressive therapy : Systemic lupus erythematosus

• Published in: Zeitschrift für Rheumatologie 2017-02, Vol.76 (1), p.27-32
• Main Authors: Aringer, M, Leuchten, N, Fischer-Betz, R
• Format: Article
• Language: ger
• Subjects: Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Monitoring - methods; Evidence-Based Medicine; Humans; Immunologic Factors - administration & dosage; Immunologic Factors - adverse effects; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - adverse effects; Lupus Erythematosus, Systemic - diagnosis; Lupus Erythematosus, Systemic - drug therapy; Treatment Outcome
• ISSN: 1435-1250
• DOI: 10.1007/s00393-016-0258-0

Similar to patients with other rheumatic diseases, patients with systemic lupus erythematosus (SLE) nowadays can also have the desire to terminate immunosuppressive and immunomodulatory medications. In order to provide appropriate advice to patients, the two main issues are the risk of severe adverse events under long-term therapy with any drug and the perceived risk of a flare, in particular of severe flares. The risks of long-term therapy vary greatly between drugs, ranging from severe unacceptable risks with cyclophosphamide and higher dose glucocorticoids to low risks usually outweighed by long-term benefits with hydroxychloroquine. The individual risk of flares is often difficult to estimate but clinical remission and at least 3 years of immunosuppression are recommended for lupus nephritis. The duration of remission can also be shorter in cases of milder forms of disease. This review article tries to put the available evidence into a clinical perspective and to derive concrete recommendations.