EULAR recommendations for the management of systemic lupus erythematosus: 2023 update

Publikation: Beitrag in FachzeitschriftForschungsartikelBeigetragenBegutachtung

Beitragende

  • Antonis Fanouriakis - , Attikon University Hospital (Autor:in)
  • Myrto Kostopoulou - , Attikon University Hospital (Autor:in)
  • Jeanette Andersen - , Lupus Europe (Autor:in)
  • Martin Aringer - , Medizinische Klinik und Poliklinik III, Universitätsklinikum Carl Gustav Carus Dresden (Autor:in)
  • Laurent Arnaud - , Université de Strasbourg (Autor:in)
  • Sang Cheol Bae - , Hanyang University (Autor:in)
  • John Boletis - , National and Kapodistrian University of Athens (Autor:in)
  • Ian N. Bruce - , University of Manchester (Autor:in)
  • Ricard Cervera - , Hospital Clínic de Barcelona (Autor:in)
  • Andrea Doria - , Università degli studi di Padova (Autor:in)
  • Thomas Dörner - , Charité – Universitätsmedizin Berlin (Autor:in)
  • Richard A. Furie - , Northwell Health System (Autor:in)
  • Dafna D. Gladman - , University of Toronto (Autor:in)
  • Frederic A. Houssiau - , Université catholique de Louvain (Autor:in)
  • Luís Sousa Inês - , University of Coimbra (Autor:in)
  • David Jayne - , University of Cambridge (Autor:in)
  • Marios Kouloumas - , Cyprus League Against Rheumatism (Autor:in)
  • László Kovács - , University of Szeged (Autor:in)
  • Chi Chiu Mok - , Tuen Mun Hospital (Autor:in)
  • Eric F. Morand - , Monash University (Autor:in)
  • Gabriella Moroni - , Humanitas University (Autor:in)
  • Marta Mosca - , University of Pisa (Autor:in)
  • Johanna Mucke - , Heinrich Heine Universität Düsseldorf (Autor:in)
  • Chetan B. Mukhtyar - , Norfolk and Norwich University Hospitals NHS Foundation Trust (Autor:in)
  • György Nagy - , Buda Hospital of the Hospitaller Order of Saint John of God, Semmelweis University (Autor:in)
  • Sandra Navarra - , University of Santo Tomas (Autor:in)
  • Ioannis Parodis - , Karolinska Institutet, Örebro University (Autor:in)
  • José M. Pego-Reigosa - , University Hospital Complex of Vigo (Autor:in)
  • Michelle Petri - , Johns Hopkins Medicine (Autor:in)
  • Bernardo A. Pons-Estel - , Grupo Oroño (Autor:in)
  • Matthias Schneider - , Heinrich Heine Universität Düsseldorf (Autor:in)
  • Josef S. Smolen - , Medizinische Universität Wien (Autor:in)
  • Elisabet Svenungsson - , Karolinska Institutet (Autor:in)
  • Yoshiya Tanaka - , University of Occupational and Environmental Health, Japan (Autor:in)
  • Maria G. Tektonidou - , National and Kapodistrian University of Athens (Autor:in)
  • YK Onno Teng - , Leiden University (Autor:in)
  • Angela Tincani - , University of Brescia (Autor:in)
  • Edward M. Vital - , University of Leeds (Autor:in)
  • Ronald F. Van Vollenhoven - , Amsterdam University Medical Centers (UMC) (Autor:in)
  • Chris Wincup - , King's College London (KCL) (Autor:in)
  • George Bertsias - , Heraklion University Hospital (Autor:in)
  • Dimitrios T. Boumpas - , Attikon University Hospital, Academy of Athens, National and Kapodistrian University of Athens (Autor:in)

Abstract

Objectives To update the EULAR recommendations for the management of systemic lupus erythematosus (SLE) based on emerging new evidence. Methods An international Task Force formed the questions for the systematic literature reviews (January 2018-December 2022), followed by formulation and finalisation of the statements after a series of meetings. A predefined voting process was applied to each overarching principle and recommendation. Levels of evidence and strengths of recommendation were assigned, and participants finally provided their level of agreement with each item. Results The Task Force agreed on 5 overarching principles and 13 recommendations, concerning the use of hydroxychloroquine (HCQ), glucocorticoids (GC), immunosuppressive drugs (ISDs) (including methotrexate, mycophenolate, azathioprine, cyclophosphamide (CYC)), calcineurin inhibitors (CNIs, cyclosporine, tacrolimus, voclosporin) and biologics (belimumab, anifrolumab, rituximab). Advice is also provided on treatment strategies and targets of therapy, assessment of response, combination and sequential therapies, and tapering of therapy. HCQ is recommended for all patients with lupus at a target dose 5 mg/kg real body weight/day, considering the individual's risk for flares and retinal toxicity. GC are used as 'bridging therapy' during periods of disease activity; for maintenance treatment, they should be minimised to equal or less than 5 mg/day (prednisone equivalent) and, when possible, withdrawn. Prompt initiation of ISDs (methotrexate, azathioprine, mycophenolate) and/or biological agents (anifrolumab, belimumab) should be considered to control the disease and facilitate GC tapering/discontinuation. CYC and rituximab should be considered in organ-threatening and refractory disease, respectively. For active lupus nephritis, GC, mycophenolate or low-dose intravenous CYC are recommended as anchor drugs, and add-on therapy with belimumab or CNIs (voclosporin or tacrolimus) should be considered. Updated specific recommendations are also provided for cutaneous, neuropsychiatric and haematological disease, SLE-associated antiphospholipid syndrome, kidney protection, as well as preventative measures for infections, osteoporosis, cardiovascular disease. Conclusion The updated recommendations provide consensus guidance on the management of SLE, combining evidence and expert opinion.

Details

OriginalspracheEnglisch
Seiten (von - bis)15-29
Seitenumfang15
FachzeitschriftAnnals of the rheumatic diseases
Jahrgang83
Ausgabenummer1
Frühes Online-Datum12 Okt. 2023
PublikationsstatusVeröffentlicht - Jan. 2024
Peer-Review-StatusJa

Externe IDs

Scopus 85174394977
PubMed 37827694

Schlagworte

Ziele für nachhaltige Entwicklung

Schlagwörter

  • Autoimmune Diseases, Lupus Erythematosus, Systemic, Lupus Nephritis