April 10, 2019
New recommendations for treating systemic lupus erythematosus were just issued by EULAR – the European League Against Rheumatism (EULAR) and published in Annals of the Rheumatic Diseases . A group of researchers from 29 medical centers across Europe reviewed all the current literature on lupus treatment to formulate questions, elicit expert opinions and reach a consensus on the new recommendations. The last recommendations from EULAR were published in 2008, which led to specific recommendations on monitoring lupus, treating neuropsychiatric and kidney disease, managing pregnancy and women’s health with lupus. The new guidelines were warranted by subsequent data on treatment goals and strategies, acceptance of different uses of steroids, use of calcineurin inhibitors to treat lupus nephritis and the approval of belimumab (Benlysta®).
To summarize, the new guidelines recommend the following:
“Treatment in SLE aims at remission or low disease activity and prevention of flares. Hydroxychloroquine is recommended in all patients with lupus, at a dose not exceeding 5 mg/kg real body weight. During chronic maintenance treatment, glucocorticoids (GC) should be minimised to less than 7.5 mg/day (prednisone equivalent) and, when possible, withdrawn. Appropriate initiation of immunomodulatory agents (methotrexate, azathioprine, mycophenolate) can expedite the tapering/discontinuation of GC. In persistently active or flaring extrarenal disease, add-on belimumab should be considered; rituximab (RTX) may be considered in organ-threatening, refractory disease. Updated specific recommendations are also provided for cutaneous, neuropsychiatric, haematological and renal disease. Patients with SLE should be assessed for their antiphospholipid antibody status, infectious and cardiovascular diseases risk profile and preventative strategies be tailored accordingly. The updated recommendations provide physicians and patients with updated consensus guidance on the management of SLE, combining evidence-base and expert-opinion.”