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2018 update of the EULAR recommendations for the management of systemic lupus erythematosus

2018 update of the EULAR recommendations for the management of systemic lupus erythematosus. Target population/question. Patients with systemic lupus erythematosus (SLE).

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2018 update of the EULAR recommendations for the management of systemic lupus erythematosus

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  1. 2018 update of the EULAR recommendations for the management of systemic lupus erythematosus

  2. Target population/question • Patients with systemic lupus erythematosus (SLE). • To update the previous (2007) EULAR recommendations for the management of SLE, based on available evidence and expert opinion.

  3. 2017 Update of the EULAR Recommendations for the management of SLE Methods/methodologicalapproach Consensual approach • Main research questions (including specific topics of interest) Systematic literature research (SLR) • Extrapolation of the SLR results to inform clinically relevant topics • Draft of initial statements based on available evidence and expert opinion Consensual approach FINAL Recommendations van der Heijde D, et al. Ann Rheum Dis. 2015; 74: 8-13

  4. 2017 Update of the EULAR Recommendations for the management of SLE Methods/methodologicalapproach • Pharmacologic treatment of SLE (Questions 1 to 5) • Glucocorticoids(different regimens; acute versus chronic treatment; “safe” dose; tapering schemes; steroid-free regimens) • Antimalarials (optimal dose during maintenance) • Immunosuppressives/cytotoxics (methotrexate, azathioprine, mycophenolate, cyclophosphamide) • Calcineurin inhibitors (CNIs) (use in renal and non-renal lupus) • Biologics (evidence on belimumab and off-label agents; indications and use as induction versus maintenance) • Management of specific manifestations (Questions 6 to 10) • Skin manifestations (topical and systemic treatments; according to different subtypes) • Lupus Nephritis (comparative efficacy of induction regimens; long-term efficacy data; role of CNIs in multi-target regimens) • NPSLE (attribution of NP events; indications for immunosuppressive or biologic treatment) • APS • SLE flares (prevention of flares; therapeutic agents specifically tested for flares)

  5. 2017 Update of the EULAR Recommendations for the management of SLE Methods/methodologicalapproach • Monitoring SLE and treatment targets (Questions 11 to 13) • Assessment of disease activity and organ damage (how often, by what means) • Therapeutic target(s) • Duration of maintenance immunosuppressive/biologic treatment • Comorbidities and adjunct therapy (Question 14) • Focus on cardiovascular disease and infections (risk stratification, prevention)

  6. Overarchingprinciples • SLE is a multisystem disease - occasionally limited to one or few organs - diagnosed on clinical grounds in the presence of characteristic serologic abnormalities. • SLE care is multidisciplinary, based on a shared patient-physician decision, and should consider individual, medical and societal costs. • Treatment of organ-/life-threatening SLE includes an initial period of high-intensity immunosuppressive therapy to control disease activity, followed by a longer period of less intensive therapy to consolidate response and prevent relapses. • Treatment goals include long-term patient survival, prevention of organ damage and optimization of health-related quality of life.

  7. Individual Recommendations1. Goals of treatment LoE: Level of Evidence; GoR: Grade of Recommendation

  8. Individual Recommendations2. Treatment of SLE (general) 2.1 Hydroxychloroquine LoE: Level of Evidence; GoR: Grade of Recommendation

  9. Individual Recommendations2. Treatment of SLE (general) 2.2 Glucocorticoids LoE: Level of Evidence; GoR: Grade of Recommendation

  10. Individual Recommendations2. Treatment of SLE (general) 2.3 Immunosuppressive therapies LoE: Level of Evidence; GoR: Grade of Recommendation

  11. Individual Recommendations2. Treatment of SLE (general) 2.4 Biologics LoE: Level of Evidence; GoR: Grade of Recommendation

  12. Individual Recommendations3. Specific manifestations 3.1 Skin disease LoE: Level of Evidence; GoR: Grade of Recommendation

  13. Individual Recommendations3. Specific manifestations 3.2 Neuropsychiatric disease LoE: Level of Evidence; GoR: Grade of Recommendation

  14. Individual Recommendations3. Specific manifestations 3.3 Haematologic disease LoE: Level of Evidence; GoR: Grade of Recommendation

  15. Individual Recommendations3. Specific manifestations 3.4 Renal disease LoE: Level of Evidence; GoR: Grade of Recommendation

  16. Individual Recommendations3. Specific manifestations 3.4 Renal disease LoE: Level of Evidence; GoR: Grade of Recommendation

  17. Individual Recommendations4. Comorbidities 4.1 Antiphospholipid antibodies and antiphospholipid syndrome LoE: Level of Evidence; GoR: Grade of Recommendation

  18. Individual Recommendations4. Comorbidities 4.2 Infectious diseases LoE: Level of Evidence; GoR: Grade of Recommendation

  19. Individual Recommendations4. Comorbidities 4.3 Cardiovascular disease LoE: Level of Evidence; GoR: Grade of Recommendation

  20. Summary Table Oxford Level of Evidence and Agreement

  21. Summary Table Oxford Level of Evidence and Agreement

  22. Summary Table Oxford Level of Evidence and Agreement

  23. Summary Table Oxford Level of Evidence and Agreement

  24. Summary of Recommendations in lay format 1 star (*) means it is a weak recommendation with limited scientific evidence; 2 stars (**) means it is a weak recommendation with some scientific evidence; 3 stars (***) means it is a strong recommendation with quite a lot of scientific evidence; 4 stars (****) means it is a strong recommendation supported with a lot of scientific evidence. Recommendations with just 1 or 2 stars are based mainly on expert opinion and not backed up by appropriate clinical studies, but may be as important as those with 3 and 4 stars.

  25. Summary of Recommendations in lay format 1 star (*) means it is a weak recommendation with limited scientific evidence; 2 stars (**) means it is a weak recommendation with some scientific evidence; 3 stars (***) means it is a strong recommendation with quite a lot of scientific evidence; 4 stars (****) means it is a strong recommendation supported with a lot of scientific evidence. Recommendations with just 1 or 2 stars are based mainly on expert opinion and not backed up by appropriate clinical studies, but may be as important as those with 3 and 4 stars.

  26. Acknowledgements Task Force

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