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The Great Pediatric Debate—Corticosteroids in SLE: Slay or Stay?

Michael Cammarata, MD, RhMSUS  |  Issue: January 2026  |  

In her closing arguments, she shared data showing that 5 mg of prednisone daily leads to a fourfold annual reduction in moderate to severe flares in patients with quiescent SLE, without an associated increase in infection or damage.17 She also called attention to a statement from EULAR emphasizing that steroid-related harm is dose dependent, and that doses of 5 mg or less are associated with an acceptably low risk of harm.18

In Sum

After both presentations, live audience polling data didn’t budge, re-demonstrating that about 60% of attendees favored an attempt at tapering prednisone. Ultimately, corticosteroid tapering requires a careful weighing of the risks and benefits of doing so and is dependent on a number of complex variables, including the SLE phenotype, burden of steroid toxicity, and patient and provider comfort with risk.

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The session closed with a joint call to action, advocating for an attempt at tapering when feasible, bearing in mind patient preferences. The speakers also encouraged future research focusing on heterogeneity in response to corticosteroids, as well as new steroid-sparing agents.

Dr. Michael Cammarata

Dr. Michael Cammarata

Michael Cammarata, MD, RhMSUS, is an assistant professor of medicine at the Johns Hopkins University School of Medicine in Baltimore.

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