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

医学 贝里穆马布 硫唑嘌呤 美罗华 羟基氯喹 狼疮性肾炎 任天堂 依法利珠单抗 阿巴塔克普 系统性红斑狼疮 强的松 维持疗法 重症监护医学 内科学 免疫学 疾病 英夫利昔单抗 特发性肺纤维化 B细胞激活因子 B细胞 2019年冠状病毒病(COVID-19) 淋巴瘤 传染病(医学专业) 抗体 化疗
作者
Antonis Fanouriakis,Myrto Kostopoulou,Jeanette Andersen,Martin Aringer,Laurent Arnaud,Sang Cheol Bae,John Boletis,Ian N. Bruce,Ricard Cervera,Andrea Doria,Thomas Dörner,Richard Furie,Dafna Gladman,Frédéric Houssiau,Luís Inês,David Jayne,Marios Kouloumas,László Kovács,Chi Chiu Mok,Eric Morand,Gabriella Moroni,Marta Mosca,Johanna Mücke,Chetan Mukhtyar,György Nagy,Sandra V. Navarra,Ioannis Parodis,José María Pego-Reigosa,Michelle Petri,Bernardo A Pons-Éstel,Matthias Schneider,Josef S. Smolen,Elisabet Svenungsson,Yoshiya Tanaka,Maria G. Tektonidou,Y K Onno Teng,Anǵela Tincani,Edward M Vital,Ronald van Vollenhoven,Chris Wincup,George Βertsias,Dimitrios T. Boumpas
出处
期刊:Annals of the Rheumatic Diseases [BMJ]
卷期号:83 (1): 15-29 被引量:40
标识
DOI:10.1136/ard-2023-224762
摘要

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.
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