In the 194-patient phase 3 INDIGO trial, weekly subcutaneous obexelimab, a bifunctional antibody that dampens B cells through CD19 and FcγRIIb without depleting them, cut the risk of IgG4-related disease flare by more than half (HR 0.44) and reduced rescue glucocorticoid exposure by about two-thirds over 52 weeks. The comparator was a steroid taper alone, and fewer than 4 in 10 patients on obexelimab reached complete remission.
There are no PJP prophylaxis guidelines for rheumatic disease, so practice varies widely between clinicians. This review assembles what the evidence supports: prophylaxis clearly works, the harms are real enough to matter, and the number needed to treat swings from about 4 in VEXAS to over 900 in rheumatoid arthritis — which is why the underlying disease, not the steroid dose alone, should drive the decision.
Glucocorticoids remain the leading cause of secondary osteoporosis, and oral steroid use in rheumatic disease has risen over the last twenty years despite steroid-sparing agents. This review covers how quickly bone is lost, why DXA systematically underestimates fracture risk on steroids, how much the underlying rheumatic disease contributes, the steroid-sparing evidence in SLE, GCA, PMR and ANCA vasculitis, and what the trial data actually support.
A full map of EGPA therapy — why reduced-dose steroid regimens validated in GPA and MPA may not transfer, what REOVAS and MAINRITSEG actually showed about rituximab (no superiority in either), and how anti-IL-5 therapy has made complete glucocorticoid withdrawal a realistic trial endpoint. Also carries a development many will have missed: avacopan’s marketing approval is being withdrawn after ADVOCATE’s primary endpoint data were found to have been manipulated.
Secukinumab doubled sustained remission at 52 weeks in relapsed polymyalgia rheumatica — 41% versus 20% on a prednisone taper alone — and halved the need for escape steroid. But 150 mg worked as well as 300 mg, the component data show the drug maintains remission rather than inducing it, and roughly six in ten treated patients still did not reach the endpoint.
ALLEGORY is a phase 3 RCT of the type II anti-CD20 antibody obinutuzumab added to standard therapy in active non-renal SLE. It met its primary endpoint (SRI-4 76.7% vs 53.5% at week 52) and all five key secondary endpoints, achieving both steroid-sparing and a ~40% reduction in flare hazard — reinforcing that depth of B-cell depletion matters and that type II succeeds where rituximab failed.
A 2026 review of steroid-sparing therapy across the GCA–PMR spectrum: glucocorticoids still induce remission but drive substantial cumulative toxicity, so the field has pivoted to IL-6 receptor inhibition (tocilizumab in GCA, sarilumab in PMR) and JAK inhibition (upadacitinib now approved for GCA) — none of which reliably restores treatment-free remission, against a backdrop of weak monitoring tools and GCA-specific vascular-damage risk.
A propensity-score analysis of the Lupus–Cruces–Bordeaux inception cohort: early (first-year) methylprednisolone pulses were associated with a ~40% reduction in long-term irreversible damage or death in active SLE, with benefit concentrated in moderate–severe disease — likely reflecting an MP-anchored low-steroid strategy rather than the molecule alone.