Glucocorticoids and other immunosuppressants still represent the cornerstone drugs for the management of SLE and lupus nephritis. The refined use of these drugs over the years has allowed us to obtain stable disease remission and improvement of long-term kidney and patient survival. Nevertheless, a prolonged use of immunosuppressive agents may be accompanied by severe and even life-threatening side effects. Theoretically, a transient or even definitive withdrawal of immunosuppression could be useful to prevent iatrogenic morbidities. For many years, however, the risk of SLE reactivation has held clinicians back from trying to interrupt therapy. In this review, we report the results of the attempts to interrupt glucocorticoids and other immunosuppressive agents in lupus nephritis and in SLE. The available data suggest that therapy withdrawal is feasible at least in patients enjoying a complete clinical remission after a prolonged therapy. A slow and gradual reduction of treatment under medical surveillance is needed to prevent flares of activity. After therapy withdrawal, around one-quarter of patients may have kidney or systemic flares. However, most flares may respond to therapy if rapidly diagnosed. The other patients can enter stable remission for even 20 years or more. The use of antimalarials can help in maintaining the remission after the withdrawal of the immunosuppressive therapy. A repeated kidney biopsy could be of help in deciding to stop therapy, but given the few available data, it cannot be considered essential.

糖皮质激素和其他免疫抑制剂仍然是治疗系统性红斑狼疮和狼疮性肾炎的基石药物。多年来这些药物的精细化使用使我们获得了稳定的疾病缓解以及长期肾脏和患者生存率的改善。然而，长期使用免疫抑制剂可能会伴随严重甚至危及生命的副作用。从理论上讲，免疫抑制的短暂甚至最终撤除可能有助于预防医源性并发症。然而，多年来，SLE 复发的风险一直阻碍临床医生尝试中断治疗。在这篇综述中，我们报告了在狼疮性肾炎和 SLE 中尝试中断糖皮质激素和其他免疫抑制剂的结果。现有数据表明，至少在长期治疗后获得完全临床缓解的患者中，停药是可行的。需要在医疗监督下缓慢和逐渐减少治疗，以防止活动突然发作。停止治疗后，大约四分之一的患者可能出现肾脏或全身性疾病发作。然而，如果迅速诊断，大多数耀斑可能会对治疗产生反应。其他患者甚至可以进入稳定缓解期长达 20 年或更长时间。使用抗疟药有助于维持免疫抑制治疗后的缓解。重复肾活检可能有助于决定停止治疗，但鉴于可用数据很少，不能认为它是必要的。需要在医疗监督下缓慢和逐渐减少治疗，以防止活动突然发作。停止治疗后，大约四分之一的患者可能出现肾脏或全身性疾病发作。然而，如果迅速诊断，大多数耀斑可能会对治疗产生反应。其他患者甚至可以进入稳定缓解期长达 20 年或更长时间。使用抗疟药有助于维持免疫抑制治疗后的缓解。重复肾活检可能有助于决定停止治疗，但鉴于可用数据很少，不能认为它是必要的。需要在医疗监督下缓慢和逐渐减少治疗，以防止活动突然发作。停止治疗后，大约四分之一的患者可能出现肾脏或全身性疾病发作。然而，如果迅速诊断，大多数耀斑可能会对治疗产生反应。其他患者甚至可以进入稳定缓解期长达 20 年或更长时间。使用抗疟药有助于维持免疫抑制治疗后的缓解。重复肾活检可能有助于决定停止治疗，但鉴于可用数据很少，不能认为它是必要的。其他患者甚至可以进入稳定缓解期长达 20 年或更长时间。使用抗疟药有助于维持免疫抑制治疗后的缓解。重复肾活检可能有助于决定停止治疗，但鉴于可用数据很少，不能认为它是必要的。其他患者甚至可以进入稳定缓解期长达 20 年或更长时间。使用抗疟药有助于维持免疫抑制治疗后的缓解。重复肾活检可能有助于决定停止治疗，但鉴于可用数据很少，不能认为它是必要的。