EULAR recommendations 2023 on the treatment of systemic lupus erythematosus-Implications for treatment in Germany

Abstract

The 2023 update of the EULAR recommendations for the management of systemic lupus erythematosus (SLE) faced several tasks: the newly approved medications anifrolumab and voclosporin as well as the additional approval of belimumab for lupus nephritis had to be conceptionally fitted into the management of SLE. Novel data on hydroxychloroquine and glucocorticoids, additional results for the treat-to-target goals remission and low disease activity and experience with respect to vaccinations and infections had to be considered. Additionally, EULAR specified aslightly modified structure. The update was further developed with 5overarching principles and 13recommendations. An SLE activity score is required for each patient visit. All SLE patients should receive hydroxychloroquine at atarget dose of 5 mg/kg body weight. Glucocorticoids should only be used if necessary and reduced to not more than 5 mg prednisone equivalent daily in the long-term or, even better, tapered off. If the target of remission or low disease activity is not reached, methotrexate, azathioprine, mycophenolate and/or belimumab or anifrolumab should be used. For lupus nephritis, Euro-Lupus cyclophosphamide or mycophenolate are options for induction therapy and mycophenolate or azathioprine for maintenance. In the case of severe nephritis, the addition of belimumab or acalcineurin inhibitor (voclosporin or tacrolimus) should be considered. It is important that treatment should be continued for at least 3years. This review article describes the details of the new recommendations against the background of relevant studies in recent years and classifies them in the clinical context.