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Topics:
Rheumatology • Systemic lupus erythematosus
For which SLE manifestations or disease activity markers do you generally recommend escalation to a biologic in a patient who does not have apparent renal involvement?
Over what time course do you typically do this? Do you generally escalate in a stepwise fashion with a certain amount of time on traditional DMARDs or recommend multi-drug therapy upfront, similar to what is now recommended in LN?
Answer from: at Academic Institution
For renal lupus, mycophenolate is no longer sufficient as induction therapy: either belimumab or calcineurin inhibitors should be added. For non-renal lupus, EULAR 2023 guidelines (Fanouriakis et al., PMID 37827694) state that immunosuppressives and/or biologics can be added. Gatto et al have shown ...
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Answer from: at Academic Institution
If the patient's skin disease, arthritis, pericarditis, mucosal disease, alopecia, etc., do not respond to mycophenylate, leflunomide, with plaquenil, then I will go with a biologic after 3 months of maximum therapy. I have a low threshold for starting belimumab due to its safety profile. I do treat...