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SLE — SCE Rheumatology MCQ

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HardSLE & Antiphospholipid SyndromeSLESCE Rheumatology

A 32-year-old woman with SLE and active nephritis has a rising anti-dsDNA titre. She has recently been diagnosed with class IV+V lupus nephritis. She is started on Mycophenolate and glucocorticoids. According to EULAR 2023, which add-on therapy should be considered from the start to improve renal outcomes?

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Correct answer: D — Belimumab or Voclosporin

EULAR 2023 represents a paradigm shift in lupus nephritis management, recommending that add-on therapy with Belimumab or a calcineurin inhibitor (Voclosporin or Tacrolimus) should be considered from the start for all patients with active proliferative lupus nephritis. This early combination approach aims to improve renal response rates, based on the BLISS-LN trial (Belimumab) and AURORA-1 trial (Voclosporin). This moves away from the traditional sequential escalation model.

Reference: EULAR 2023 - Recommendations for management of SLE