EULAR 2023 Lupus Recommendations: Use Biologics, Taper Steroids

15 Jun 2023 • According to the latest recommendations on the management of SLE from the European Alliance of Associations for Rheumatology (EULAR), treatment of systemic lupus erythematosus with biologics may enable steroid tapering while ensuring the achievement of remission or low disease activity in more patients with fewer flares and less organ damage, as well as leading to better responses if used early.

  • Dr. Boumpas, Chair of the European Task force on SLE, reported that hydroxychloroquine should be a first-line therapy at a dose of 5 mg/kg, but this dose should be individualized based on risk of flare and retinal toxicity.
  • The second statement, meanwhile, contains a new recommendation, which is that 5 mg or less per day of prednisone is preferred for a maintenance dose, compared with 7.5 mg per day from the previous iteration.
  • The third recommendation deals with disease-modifying antirheumatic drugs and biologics as steroid sparing agents. Specifically, the clinician can choose methotrexate, azathioprine, belimumab or anifrolumab.
  • For statement four, cyclophosphamide or rituximab may be considered for severe, life-threatening disease.
  • Another change is seen in the fifth statement, where it is suggested that for skin disease, after methotrexate or hydroxychloroquine, belimumab or anifrolumab may be considered.
  • An additional key change in the seventh recommendation notes that the “new kid on the block,” mycophenolate mofetil, can be used in a maintenance therapy role, according to Boumpas.
  • The eighth statement pertains to lupus nephritis. Belimumab and voclosporin should be considered in all patients with lupus nephritis “from the beginning,” Boumpas said.
  • The other big change in the 2023 document pertains to maintenance therapy for lupus nephritis. Patients should be treated for at least 3 years with some combination of mycophenolate mofetil, belimumab, azathioprine or cyclophosphamide.

There are 13 total statements in the updated EULAR lupus recommendations. Boumpas encouraged attendees to review all of the recommendations to stay on the cutting edge of treatment protocols.

Source: Medscape | Read full story

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