Based on findings, glucocorticoid discontinuation is supported to be a therapeutic target in pediatric systemic lupus erythematosus (SLE).

• In this single-center study of 31 children with newly diagnosed pediatric SLE, a median follow-up of 105.5 (range, 17–221) months revealed that discontinuation of glucocorticoids could be achieved in 19 (61%) patients.

• Glucocorticoid discontinuation could be achieved in 5 (26%), 12 (63%), and 18 (95%) of these patients in 3, 5, and 10 years from treatment initiation, respectively.

• Post-glucocorticoid discontinuation, no flares occurred in 18 of the 19 patients, and drug-free remission was achieved by three of the 19 patients.

• Low disease activity with or without glucocorticoids was achieved in all cases at last follow-up and 19, 8, and 1 patient were taking mycophenolate mofetil (MMF), MMF plus tacrolimus, and MMF plus ciclosporin A, respectively.

• Flares occurred in 15 cases during observation, and MMF as initial immunosuppressant and shorter interval between therapy initiation and achieving maintenance prednisolone dose of 0.1–0.15 mg/kg/day were found to be linked with significantly decreased flare risk.

• Two patients developed femoral head necrosis.