Background: Glucocorticoids (GCs) are important for the management of systemic lupus erythematosus (SLE); however, chronic use is associated with significant adverse effects and organ damage. Despite the general recommendation to taper GCs in order to minimise organ damage accrual, detailed guidance on how to taper is lacking.

Objectives: We outline the planned methods for a modified Delphi exercise to develop consensus-based recommendations on 1) best practices when tapering GCs and 2) specific tapering schedules for patients with SLE.

Methods: Literature review:

An initial review of the literature on GC tapering in SLE and lupus nephritis was carried out, reviewing papers from PubMed and The Lancet Rheumatology published between 2018 and 2023. Guidelines and recommendations on lupus management and clinical trials on the use of advanced treatments in lupus were also considered (not restricted by date). Results from the literature review were analysed by a steering committee of nine international experts and informed the development of the first round of voting statements and questions.

Delphi rounds:

Two online Delphi rounds will be carried out. In round 1, respondents will be asked to rate their agreement with voting statements using a nine-point Likert scale, with a threshold for consensus of ≥70%. In round 2, respondents will be presented with the mean ratings, their round 1 ratings and the opportunity to revise their ratings. To gain further insights on current practice, open-ended and multiple-choice questions will also be included, and example tapering algorithms will be presented for respondents to comment on.

Respondents:

To develop robust guidance on GC tapering, snowball sampling was used to identify global lupus experts including rheumatologists, nephrologists, dermatologists and internists who will be invited to participate in the two Delphi rounds.

Results: To date, 136 respondents from 35 countries have been identified and will be invited to participate in the Delphi rounds. Respondents will be asked to rate 42 statements and answer 13 questions in the first Delphi round covering the following topics:

• Topic 1: GC-tapering regimens in lupus: general considerations. This will include when tapering should be initiated and identification of the optimal tapering regimen(s) and the goal(s) of tapering.

• Topic 2: Managing flares and patients with a high risk of flare during GC tapering.

• Topic 3: Managing GC-associated toxicity and GC withdrawal symptoms.

Conclusion: This initiative aims to provide guidance on optimising approaches to GC tapering, to more specifically define the appropriate use of GCs in SLE.

REFERENCES: NIL.

Acknowledgements: Medical writing support was provided by Helios Medical Communications and was funded by AstraZeneca in accordance with Good Publication Practice (GPP) guidelines (http://www.ismpp.org/gpp-2022). The authors retained full control of the content and made the final decisions for all aspects of this abstract.

Funding: This study is sponsored by AstraZeneca. The content of the Delphi rounds and the following consensus document will be determined independently by the steering committee.

Disclosure of Interests: George K. Bertsias Speaker fees from GSK, AstraZeneca, Pfizer, Aenorasis and Lilly, Consulting fees from GSK and Pfizer, Grant/research support from GSK and AstraZeneca, Edward M. Vital Speaking fees from AstraZeneca, Consulting fees from AstraZeneca, Grant from AstraZeneca paid to the University of Leeds, Andrea Doria Speaker fees from GSK, Otsuka Pharmaceutical, AstraZeneca and Galapagos, consulting fees from GSK, Otsuka Pharmaceutical, AstraZeneca and BMS, Sindhu R. Johnson: None declared, Sarah Mackie Speaker fees paid to institution from Pfizer, Vifor Pharma, Chugai, UCB and AbbVie, Consulting fees paid to institution from Sanofi, AbbVie and AstraZeneca, Grant/research support from Roche and Vifor Pharma, Bernardo Pons-Estel Speaker fees from GSK, AstraZeneca and Janssen, Grant/research support from Janssen, Y.K. Onno Teng Consulting fees paid to institution from Aurinia Pharmaceuticals, Novartis, GSK, KezarBio, Vifor Pharma and Otsuka Pharmaceutical, Grant/research support from Vifor Pharma, Jinoos Yazdany Consulting fees from ImmPACT Bio, Pfizer, AstraZeneca and BMS, Grant/research support from Gilead, Aurinia and BMS, Sandra Navarra Speaker fees from AstraZeneca, Pfizer, GSK, Astellas Pharma, Aurinia Pharmaceuticals and Roche, Consulting fees from Biogen.