Lupus & antiphospholipid syndrome
EULAR recommendations for the management of systemic lupus erythematosus: 2023 update
Methodological detailsrecommendations, systematic literature reviews (January 2018-December 2022), international Task Force, predefined voting process, levels of evidence and strengths of recommendation assigned
- Recommendations
- Systematic literature reviews (January 2018-December 2022)
- International Task Force
- Predefined voting process
- Levels of evidence and strengths of recommendation assigned
Recommendations
As issued by the authors
Hydroxychloroquine (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.
Glucocorticoids (GC) are used as 'bridging therapy' during periods of disease activity; for maintenance, minimised to equal or less than 5 mg/day (prednisone equivalent) and, when possible, withdrawn.
Prompt initiation of immunosuppressive drugs (ISDs) (MTX, AZA, 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 LN, GC, mycophenolate or low-dose intravenous CYC are recommended as anchor drugs; add-on belimumab or calcineurin inhibitors (CNIs) (voclosporin or tacrolimus) should be considered.
Updated specific recommendations for cutaneous, neuropsychiatric and haematological disease, systemic lupus erythematosus (SLE)-associated APS, kidney protection, and prevention of infections, osteoporosis and CVD.
Original publication
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