According to a report from Medscape, investigators have recommended that treatment with biologics may enable steroid tapering while ensuring the achievement of remission or low disease activity in patients who have systemic lupus erythematosus, with fewer disease flares and less organ damage. In the new study—presented by Boumpas et al at the EULAR 2023 Congress and simultaneously published in the Annals of Rheumatic Diseases—the investigators reviewed 7,000 articles via PubMed and included data on new treatment strategies, the adverse effects of chronic glucocorticoid use, and newly approved agents and combination therapies. The investigators advised physicians to follow a multidisciplinary individualized treatment approach; assess disease activity during each visit; tailor therapies on the basis of organ involvement status and patient preference; and encourage patients to limit sun exposure, quit smoking, and eat healthy. Among the new recommendations were:
- Hydroxychloroquine should be used as first-line therapy at 5 mg/kg but personalized after determining flare risk and retinal toxicity.
- The maintenance dose of glucocorticoids should be 5 mg/kg or less for patients with new-onset or relapsed lupus.
- Cyclophosphamide should be considered for organ- or life-threatening disease and rituximab should be considered for refractory disease.
- Low-dose intravenous cyclophosphamide or mycophenolate as well as belimumab or calcineurin inhibitors should be considered for initial lupus nephritis therapy.
- Physicians should taper immunosuppressive agents and glucocorticoids in patients with sustained remission.