Principles of treating SLE according to the 2023 EULAR treatment recommendations update – commentary
Authors:
P. Horák
Authors‘ workplace:
III. interní klinika – nefrologická, revmatologická, endokrinologická LF UP a FN, Olomouc
Published in:
Čes. Revmatol., 32, 2024, No. 3, p. 107-115.
Category:
Úvodník
Overview
Systemic lupus erythematosus (SLE) is still a therapeutic challenge. Understanding the pathogenesis of the disease provides new therapeutic targets, leading to the registration of new drugs through clinical trials. This evolution is also reflected in the updated EULAR treatment recommendations published in 2023. The target of SLE treatment is to achieve remission or low disease activity and prevent flares while minimizing the side effects of the therapy deployed. Hydroxychloroquine is recommended for all patients with SLE at a dose not exceeding 5 mg/kg unless a contraindication is present. Glucocorticoids are now perceived as a kind of bridging therapy used optimally for a certain period and strategies to reduce their use are recommended, including early deployment of immunosuppressive and/or biologic drugs (belimumab, anifrolumab). The target dose of prednisone should be ≤ 5 mg daily. The position of biologics in the treatment of SLE is significantly strengthened in current guidelines and they can be used in first-line treatment. In the case of life- or organ-threatening disease, cyclophosphamide and, in refractory cases, rituximab is appropriate. Specific recommendations for cutaneous, neuropsychiatric, and hematological manifestations of the disease have also been updated. The recommendations for the treatment of lupus nephritis have undergone more significant changes. Not only intravenous cyclophosphamide or oral mycophenolate can be used in the treatment, but the addition of belimumab or a calcineurin inhibitor to the induction phase of treatment can also be considered. Maintenance treatment of lupus nephritis should last at least 3 years and consists of administration of mycophenolate or azathioprine, which may be combined with belimumab or a calcineurin inhibitor.
Keywords:
Systemic lupus erythematosus – remission – biologic therapy – immunosuppressive therapy – low disease activity – treatment recommen-dations
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