Rapid versus conventional glucocorticoid tapering in pure membranous lupus nephritis: a multicenter retrospective study

Objectives While recent guidelines recommend early glucocorticoid (GC) tapering for lupus nephritis (LN), supporting evidence for pure membranous LN remains limited. The present study investigated the impact of rapid GC tapering on renal outcomes in this population. Methods We performed a multicenter retrospective study across 16 centers in Japan, including 67 patients with biopsy-proven pure membranous LN who initiated GC therapy between 2003 and 2023. Patients were classified into rapid tapering (GC dose ≤7.5 mg/day at 6 months) and conventional tapering (>7.5 mg/day at 6 months) groups. The primary endpoint was the partial renal response (PRR) at 12 months. Secondary endpoints included the complete renal response (CRR), relapse, and severe adverse events (SAEs). Adjusted risk ratios (aRRs) were estimated using modified Poisson regression models for failure to achieve PRR/CRR. Results Fifteen patients underwent rapid tapering and 52 conventional tapering. Baseline characteristics were generally comparable. At 12 months, PRR was achieved in 85.7% of the rapid group and 84.3% of the conventional group (aRR for failure 1.04; 95% confidence interval [CI] 0.17-6.39). CRR rates at 12 months were 64.3 and 56.9%, respectively (aRR for failure 0.90; 95% CI 0.40-2.02). At 24 months, PRR and CRR did not differ statistically between groups. Relapse occurred in 20.0% versus 7.7% (p = 0.185). No SAEs were reported in the rapid group, while three occurred in the conventional group. Conclusions Rapid GC tapering to ≤ 7.5 mg/day at 6 months appeared feasible in a subset of patients with pure membranous LN, but the findings are preliminary and should be interpreted cautiously because of the small rapid-taper group and imprecise estimates.