SLE — SCE Rheumatology MCQ

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ModerateSLE & Antiphospholipid SyndromeSLESCE Rheumatology

A 32-year-old woman with active SLE (SLEDAI 14) has persistent moderate disease despite Hydroxychloroquine and Azathioprine. According to EULAR 2023, which biologic can be added without requiring prior failure of Cyclophosphamide?

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Correct answer: A — Belimumab or Anifrolumab

EULAR 2023 states that prior use of a conventional immunosuppressive drug should NOT be mandatory for initiating a biologic in SLE. Both Belimumab and Anifrolumab can be considered for moderate-severe non-renal SLE unresponsive to Hydroxychloroquine and standard immunosuppressives. Rituximab is recommended for organ-threatening or refractory disease. Tocilizumab, Abatacept, and Infliximab are not licensed or recommended for SLE. This represents an important shift allowing earlier biologic use.

Reference: EULAR 2023 - Recommendations for the management of systemic lupus erythematosus