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Objectives To assess the effect of slow prednisolone (PDN) tapering versus maintenance of low-dose PDN on flare risk in SLE patients in remission.Methods Observational, retrospective cohort study of adults fulfilling 2019 EULAR/ACR or 2012 SLICC criteria for SLE, followed at Coimbra’s Hospital. Data were obtained from the prospective clinical registry.Eligible patients were in remission, receiving PDN 1–5 mg/day at baseline, and had at least 6 months of follow-up (January 2020–July 2025). Baseline features and ongoing therapy were collected.The primary outcome was time to first flare. Covariates were included as potential predictors of flare fixed at baseline, with only PDN dose modelled as a time-varying variable. Cox univariate and multivariate analyses estimated hazard ratios (HR, 95%CI). Variables with p<0.10 or clinical relevance entered the multivariable model, and Kaplan–Meier curves compared flare-free survival between PDN tapering and maintenance groups. Significance was set at p<0.05.Results We included 108 patients in remission receiving PDN 1–5 mg/day (90% female; mean age 31 years; median disease duration 9 years), 94% received hydroxychloroquine and 70% received immunosuppressants. Of those tapering PDN (n=72), 53% achieved complete withdrawal, requiring 11–65 months to reduce from 5 to 0 mg.During follow-up, 37 flares occurred: 73% mild, 16.2% moderate, 11% severe. At flare, PDN was increased/started in 57% of patients, and immunosuppressants intensified in 19%. Flare-free survival was longer in patients who tapered PDN versus those who maintained a low dose (median 61 vs. 24 months; p<0.001).In the multivariable model, mucocutaneous involvement (HR=2.97, 95%CI 1.65–5.32), positive antiphospholipid antibodies (aPL) (HR=2.31, 95%CI 1.43–3.71), thrombotic antiphospholipid syndrome (APS) (HR=2.05, 95%CI 1.30–3.23), and higher PDN dose (HR=1.21 per 1 mg/day, 95%CI 1.03–1.42) were predictors of flare. In a subgroup analysis of patients undergoing PDN tapering, multivariate logistic regression showed that age at diagnosis <25 years was associated with increased flare risk (OR = 3.49, 95%CI 1.03–11.8).Conclusions In this cohort, slow PDN tapering in patients in remission did not increase flare risk, and was associated with lower risk compared with low-dose PDN maintenance. Mucocutaneous involvement, positive aPL/APS, higher PDN exposure, and age at diagnosis <25 years were associated with higher risk of flares.