From the Guidelines
American and European rheumatologists generally agree on the core principles of treating systemic lupus erythematosus (SLE), with a focus on achieving remission or low disease activity and preventing flares, as recommended in the 2023 update of the EULAR recommendations 1. The treatment approach for SLE involves the use of hydroxychloroquine as first-line therapy, with a recommended dose not exceeding 5 mg/kg real body weight, as stated in the 2019 EULAR recommendations 1.
- Key aspects of SLE management include:
- Minimizing glucocorticoids (GC) to less than 7.5 mg/day (prednisone equivalent) and, when possible, withdrawing them during chronic maintenance treatment 1
- Using immunomodulatory agents, such as methotrexate, azathioprine, or mycophenolate, to expedite the tapering or discontinuation of GC 1
- Considering add-on belimumab for persistently active or flaring extrarenal disease, and rituximab for organ-threatening, refractory disease 1
- Recent evidence from the 2023 update of the EULAR recommendations suggests that anifrolumab and belimumab are superior to standard of care treatment in extrarenal disease, and that combination treatments with belimumab or voclosporin have better efficacy in patients with lupus nephritis 1.
- The ultimate goal of SLE treatment is to improve quality of life, prevent organ damage, and minimize medication side effects, with treatment decisions individualized based on disease manifestations, severity, organ involvement, and patient factors.
From the Research
Treatment of Systemic Lupus Erythematosus (SLE)
- The American College of Rheumatology and the European Alliance of Associations for Rheumatology have developed classification criteria for SLE, which include clinical factors and immunologic measures 2.
- The primary goal of treatment is to achieve disease remission or quiescence, with treatment goals including reducing disease exacerbations, hospitalizations, and organ damage due to the disease or treatment toxicity 2.
Agreement on Treatment
- There is evidence to suggest that American and European rheumatologists agree on the treatment of SLE, with hydroxychloroquine being considered a standard of care and the first-line therapy for SLE 2, 3, 4.
- Both American and European rheumatologists use immunosuppressive agents, such as azathioprine, mycophenolate mofetil, and cyclophosphamide, to treat moderate to severe disease 2, 5, 4.
- Biologic agents, such as belimumab, voclosporin, and anifrolumab, have been approved for the treatment of SLE and are used by both American and European rheumatologists 2, 6, 3.
Treatment Options
- The treatment of SLE is individualized, with the choice of treatment depending on the severity of the disease and the patient's response to treatment 2, 5, 4.
- Synthetic drugs, such as hydroxychloroquine, azathioprine, and mycophenolate mofetil, are the mainstay of therapy in SLE, with biologic agents being used in addition to these drugs 6, 3, 4.
- The use of glucocorticoids is also common in the treatment of SLE, with the goal of minimizing organ injury and controlling active disease 2, 3, 4.