Glucocorticoids in systemic lupus erythematosus: future of steroid-sparing therapy

The isolation of glucocorticoids (GC) was a tremendous achievement in the history of medicine and had a clinical impact similar to that of the discovery of insulin or antibiotics. However, with the expansion of their use, multiple side effects have become evident even patients treated with low doses. GC remain one of the main agents in the treatment of systemic lupus erythematosus (SLE). The studies of genomic and nongenomic effects of GC justified their use in lower starting doses (e.g. 30 to 40 mg daily) even in patiens with lupus nephritis. Methylprednisolone pulses and early initiation of hydroxychloroquine and immunosuppressive agents may allow more rapid tapering and discontinuation of GC in SLE patients. Development of novel steroid-sparing agents, e.g. anifrolumab, a monoclonal antibody to interferon I receptor, or voclosporin, an oral calcineurin inhibitor, may result in further improvement in the efficacy and safety of treatment.