A recent observational study published in Clinical Rheumatology has identified key predictors of successful glucocorticoid tapering in patients with Behçet’s disease who have achieved remission or low disease activity. This is particularly important because long-term glucocorticoid therapy, while effective across mucocutaneous, ocular, neurologic, and vascular manifestations, is associated with substantial morbidity, including osteoporosis, diabetes, hypertension, infections, cataracts, and cardiovascular risk. Current EULAR recommendations emphasize minimizing steroid exposure and using immunosuppressive or biologic agents as steroid-sparing therapies whenever possible.
The longitudinal cohort study enrolled 72 patients with Behçet’s disease who initiated glucocorticoid tapering after reaching remission or low disease activity and followed them for 12 months. Patients were classified as having “successful tapering” if they maintained remission or low disease activity while reducing prednisone to ≤5 mg/day, a threshold often considered physiologic replacement rather than immunosuppressive dosing. Those who flared or required higher doses were categorized as “failed tapering,” underscoring the real-world difficulty of steroid withdrawal in chronic inflammatory disease.
Multivariate analysis identified four independent predictors of successful tapering: shorter disease duration, low disease activity at onset, a low baseline severity score, and low baseline C-reactive protein levels. These variables collectively reflect a lower cumulative inflammatory burden and less organ damage. Similar patterns have been observed in other immune-mediated diseases, where early control of inflammation and low baseline biomarkers are associated with better outcomes and reduced dependence on glucocorticoids.
The findings support a treat-to-target approach in Behçet’s disease, where early and aggressive control of inflammation using conventional immunosuppressants (such as azathioprine, methotrexate, or cyclosporine) or biologic agents (including anti-TNF therapies and interferon-α) can facilitate safer steroid tapering. Patients with mild disease and low CRP at baseline may particularly benefit from structured tapering protocols with close monitoring rather than prolonged maintenance on moderate steroid doses.
From a clinical perspective, this study reinforces the need for individualized tapering strategies guided by disease duration, activity, severity scores, and inflammatory markers. Integrating these predictors into routine practice could help clinicians identify patients most likely to succeed with glucocorticoid reduction, reduce long-term toxicity, and improve quality of life in a disease that often requires multidisciplinary and lifelong management.
Reference
Zaghlol RS, Dawa GA, Makarm WK. Evaluation of predictors and clinical outcome after tapering of chronic systemic corticosteroids in Behçet’s disease patients. Clin Rheumatol. 2026 Jan;45(1):383-393.