The comprehensive framework offers clinicians a more nuanced and targeted approach to treatment.
EULAR has released comprehensive updated recommendations for managing lupus nephritis, offering a paradigm shift in approach to the complex autoimmune condition.
The recommendations, developed by a global multidisciplinary team of rheumatologists, nephrologists and patient representatives, address the critical challenge of preventing kidney disease progression in lupus patients.
The most significant change is the shift away from the historic standard of care – mycophenolate with glucocorticoids – which is now known to be inferior to several other combinations.
The guidelines were unveiled by Professor Dimitrios Boumpas at the EULAR Congress last month in Barcelona. Professor Boumpas is president of the Athens Medical Society, a member of the Academia Europaea and chair of the European Taskforce on SLE.
“Why is it important to update regular recommendations for lupus nephritis? Because renal disease is a major cause of morbidity,” he told delegates at the congress.
“Initially, I will say it’s the most important. Thanks to the contribution of the interest in investigators and patients, we have novel therapies, and we have developed, over the years, novel treatment strategies.
“And not only that, but now we are able to set up more ambitious goals of treatment that we were not able to do in the past.”
The guidelines introduce a treatment strategy that moves beyond single-medication approaches. Doctors are now encouraged to use combination therapies, including newer biologics like belimumab and otezumab, alongside traditional immunosuppressants.
The recommended treatment duration has also been extended, with experts suggesting maintaining therapy for at least three years to prevent disease progression.
Key to the new approach is a deeper understanding of kidney function in lupus patients.
Professor Boumpas said kidney damage could occur long before traditional blood tests showed significant changes, challenging previous diagnostic methods.
This highlighted the importance of proactive monitoring and treatment.
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A critical aspect of the new recommendations is the emphasis on nephroprotection. The guidelines suggest using SGLT2 inhibitors and implementing more comprehensive monitoring of kidney function.
This approach aims to slow or potentially halt the progression of kidney disease in lupus patients.
While acknowledging that not all healthcare settings had access to the newest treatments, the recommendations strongly advocated for the most comprehensive care possible.
Professor Boumpas said the guidelines provided a flexible framework that could be adapted to different medical environments while maintaining a high standard of care.
“We feel strongly, every lupus patient with renal impairment should be offered the best therapy, which is combination therapy,” he told delagates.
The EULAR guidelines are set to be published in full in the coming months, he said.
Universal hydroxychloroquine in ACR’s overhaul of SLE guidelines
Meanwhile, in a landmark revision, the American College of Rheumatology has issued its first update to the systemic lupus erythematosus treatment guidelines since 1999, placing hydroxychloroquine front and centre as a must-use therapy for all patients.
The updated guidelines, released late last month on the ACR website, strongly recommend hydroxychloroquine for every individual diagnosed with SLE, citing its well-documented benefits in reducing disease activity, flares and long-term organ damage.
The guidelines also pivot away from long-term corticosteroid use, recommending tapering daily prednisone doses to below 5mg as soon as clinically feasible.
Additionally, clinicians are encouraged to initiate immunosuppressive treatments earlier, whether conventional agents or newer biologics, tailored to disease severity and patient preferences.
These recommendations are included in a full manuscript, which will be submitted for publication in Arthritis & Rheumatology and Arthritis Care and Research later in 2025, ACR said in the guideline summary.
