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Abstract Background This study examines the association of standard-of-care systemic lupus erythematosus (SLE) medications with key outcomes such as low disease activity attainment, flares, damage accrual, and steroid-sparing, for which there is current paucity of data. Methods The Asia Pacific Lupus Collaboration (APLC) prospectively collects data across numerous sites regarding demographic and disease characteristics, medication use, and lupus outcomes. Using propensity score methods and panel logistic regression models, we determined the association between lupus medications and outcomes. Results Among 1707 patients followed over 12,689 visits for a median of 2.19 years, 1332 (78.03%) patients achieved the Lupus Low Disease Activity State (LLDAS), 976 (57.18%) experienced flares, and on most visits patients were taking an anti-malarial (69.86%) or immunosuppressive drug (76.37%). Prednisolone, hydroxychloroquine and azathioprine were utilised with similar frequency across all organ domains; methotrexate for musculoskeletal activity. There were differences in medication utilisation between countries, with hydroxychloroquine less frequently, and calcineurin inhibitors more frequently, used in Japan. More patients taking leflunomide, methotrexate, chloroquine/ hydroxychloroquine, azathioprine, and mycophenolate mofetil/mycophenolic acid were taking ≤ 7.5 mg/day of prednisolone (compared to > 7.5 mg/day) suggesting a steroid-sparing effect. Patients taking tacrolimus were more likely (Odds Ratio [95% Confidence Interval] 13.58 [2.23-82.78], p = 0.005) to attain LLDAS. Patients taking azathioprine (OR 0.67 [0.53-0.86], p = 0.001) and methotrexate (OR 0.68 [0.47-0.98], p = 0.038) were less likely to attain LLDAS. Patients taking mycophenolate mofetil were less likely to experience a flare (OR 0.79 [0.64-0.97], p = 0.025). None of the drugs was associated with a reduction in damage accrual. Conclusions This study suggests a steroid-sparing benefit for most commonly used standard of care immunosuppressants used in SLE treatment, some of which were associated with an increased likelihood of attaining LLDAS, or reduced incidence of flares. It also highlights the unmet need for effective treatments in lupus. standardofcare (SLE attainment flares accrual steroidsparing, steroidsparing steroid sparing, sparing APLC (APLC characteristics use models 170 12689 12 689 12,68 219 2 19 2.1 years 133 78.03% 7803 78 03 (78.03% LLDAS , (LLDAS) 97 57.18% 5718 57 18 (57.18% antimalarial anti malarial 69.86% 6986 69 86 (69.86% 76.37%. 7637 76.37% . 76 37 (76.37%) Prednisolone domains countries frequently Japan leflunomide chloroquine mofetilmycophenolic mycophenolic 75 7 5 7. mgday mg day compared effect Odds 95% 95 [95 Interval 1358 13 58 13.5 2.2382.78, 2238278 2.23 82.78 23 82 [2.23-82.78] 0.005 0005 0 005 OR 067 67 0.6 0.530.86, 053086 0.53 0.86 53 [0.53-0.86] 0.001 0001 001 068 68 0.470.98, 047098 0.47 0.98 47 98 [0.47-0.98] 0.038 0038 038 079 79 0.7 0.640.97, 064097 0.64 0.97 64 [0.64-0.97] 0.025. 0025 0.025 025 0.025) treatment 17 1268 1 12,6 21 2. 78.03 780 (78.03 (LLDAS 9 57.18 571 (57.18 69.86 698 6 8 (69.86 763 76.37 3 (76.37% [9 135 13. 2382 2.2382.78 223827 223 2.2 8278 82.7 [2.23-82.78 0.00 000 00 06 0. 530 0.530.86 05308 053 0.5 086 0.8 [0.53-0.86 470 0.470.98 04709 047 0.4 098 0.9 4 [0.47-0.98 0.03 003 07 640 0.640.97 06409 064 097 [0.64-0.97 002 0.02 02 126 12, 78.0 (78.0 57.1 (57.1 69.8 (69.8 76.3 (76.37 [ 238 2.2382.7 22382 22 827 82. [2.23-82.7 0.0 0.530.8 0530 05 08 [0.53-0.8 0.470.9 0470 04 09 [0.47-0.9 0.640.9 0640 [0.64-0.9 78. (78. 57. (57. 69. (69. 76. (76.3 2.2382. 2238 [2.23-82. 0.530. [0.53-0. 0.470. [0.47-0. 0.640. [0.64-0. (78 (57 (69 (76. 2.2382 [2.23-82 0.530 [0.53-0 0.470 [0.47-0 0.640 [0.64-0 (7 (5 (6 (76 2.238 [2.23-8 [0.53- [0.47- [0.64- ( [2.23- [0.53 [0.47 [0.64 [2.23 [0.5 [0.4 [0.6 [2.2 [0. [2. [0 [2