Takeaway
- The European League Against Rheumatism (EULAR) has issued 2019 recommendations for management of systemic lupus erythematosus (SLE).
- Treatment goals include patient survival, low remission or disease activity, prevention of flares, prevention of organ damage, and optimization of health-related QoL.
Why this matters
- Last recommendations were issued in 2008, before introduction of multitargeted therapy with calcineurin inhibitors for lupus nephritis, and approval of first biological therapy (belimumab).
Key points
- Updated recommendations rely on combining evidence-based review by an internal task force with expert opinion by following a modified Delphi method.
- Hydroxychloroquine is recommended for all patients at a dose no higher than 5 mg/kg real body weight.
- Glucocorticoids (GC) during chronic maintenance therapy should be minimized to <7.5 mg/day (prednisone equivalent) and withdrawn when possible.
- Immunomodulatory agents (methotrexate, azathioprine, mycophenolate) may be introduced to expedite the tapering/discontinuation of GC.
- Add-on belimumab should be considered in persistently active or flaring extrarenal disease, whereas rituximab may be considered in organ-threatening, refractory disease.
- Specific recommendations given for cutaneous, neuropsychiatric, hematological, and renal disease. For example, cutaneous first-line treatment includes GC, calcineurin inhibitors.
- All SLE patients should be assessed for their antiphospholipid antibody status and infectious and cardiovascular disease risk profile for the purpose of tailoring preventive strategies.
References
References
