Adjuvant Molecular Hydrogen Facilitates Immunosuppressant Tapering and Sustained Remission in Systemic Lupus Erythematosus: A Case Report

Abstract

Background/Aim: Management of systemic lupus erythematosus (SLE) remains challenging: intensive immunosuppression increases infection risk, whereas dose reduction may trigger disease flares. Molecular hydrogen (H2), a selective antioxidant with anti-inflammatory properties, may serve as an adjunct therapy, potentially maintaining disease control while reducing Case Report: We present a 43-year-old female with longstanding SLE who experienced recurrent hospitalized infections (pneumonia and complex urinary tract infections) under high-dose immunosuppression in 2022. A subsequent attempt to reduce her medication dosage provoked a significant disease flare in January 2023, with anti-double stranded DNA (anti-dsDNA) levels surging to 890 IU/ml and complement depletion. Oral H2 capsule therapy was initiated as an adjunct. The patient exhibited rapid and robust serologic improvement, allowing for the complete discontinuation of mycophenolic acid within one month. Over an extended follow-up through early 2026, her regimen was successfully de-escalated to a minimized monotherapy of prednisolone 10 mg/day. Her anti-dsDNA levels stabilized within a strictly normal range (<15 IU/ml), with normalized complement levels, no further infections, and profoundly reduced fatigue. Flow-cytometric profiling revealed a coordinated reprogramming of adaptive immunity toward a controlled, non-senescent state, including a homeostatic reset in the B-cell compartment and decreased active-disease-associated T cells. Conclusion: Adjuvant molecular hydrogen therapy stabilized active SLE, enabling substantial reduction of conventional immunosuppressants while maintaining durable clinical and serologic remission. This strategy may represent a promising immunosuppressant-sparing approach and warrants validation in controlled trials.