EULAR recommendations for the management of systemic lupus erythematosus: 2023 update.
The 2023 EULAR update for systemic lupus erythematosus sets 5 overarching principles and 13 recommendations, emphasizing hydroxychloroquine for all patients, minimizing glucocorticoids to 5 mg/day or less, and incorporating newer agents such as anifrolumab, belimumab, and voclosporin.
Background
EULAR updated its recommendations for the management of systemic lupus erythematosus (SLE) to reflect new evidence from January 2018 to December 2022. An international Task Force formulated questions, conducted systematic literature reviews, and applied a predefined voting process to assign levels of evidence and strengths of recommendation.
Key recommendations
The Task Force agreed on 5 overarching principles and 13 recommendations covering hydroxychloroquine, glucocorticoids, immunosuppressive drugs, calcineurin inhibitors, and biologics. Hydroxychloroquine is recommended for all patients at a target dose of 5 mg/kg real body weight/day, balanced against flare and retinal toxicity risk. Glucocorticoids should be used as bridging therapy and minimized to 5 mg/day prednisone equivalent or less for maintenance, and withdrawn when possible, with prompt initiation of immunosuppressives and/or biologics (anifrolumab, belimumab) to facilitate tapering.
Clinical implications
For active lupus nephritis, glucocorticoids plus mycophenolate or low-dose intravenous cyclophosphamide are recommended as anchor drugs, with add-on belimumab or a calcineurin inhibitor (voclosporin or tacrolimus) considered for severe disease; cyclophosphamide and rituximab are reserved for organ-threatening and refractory disease respectively. Updated guidance also addresses cutaneous, neuropsychiatric, hematological, and antiphospholipid-associated manifestations, kidney protection, and prevention of infection, osteoporosis, and cardiovascular disease, providing consensus direction that combines evidence and expert opinion.
Category
Guidelines
Source
Ann Rheum Dis
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