Sociedad Española de Reumatología guidelines for the use of biologic therapies in SLE

Updated guidelines from the Sociedad Española de Reumatología (Spanish Society of Rheumatology; SER) on the use of biologic therapies (BTs) in systemic lupus erythematosus (SLE) were published in Reumatología Clínica by Rúa-Figueroa et al. Guideline recommendations were informed by systematic reviews and expert consensus.

Key data: A total of nine recommendations and six sub-recommendations were developed. Belimumab or anifrolumab are strongly recommended for patients with non-renal SLE who have inadequate disease control with standard therapy (ST), or for those with joint or skin activity despite ST. In active proliferative lupus nephritis (LN), belimumab is strongly recommended upfront with ST induction, unless a first-line anti-calcineurin is more appropriate. Rituximab is recommended for patients who are refractory to belimumab or anifrolumab, who have severe inflammatory central nervous system (CNS) involvement, or who have severe refractory hematologic manifestations. Obinutuzumab is also suggested for patients with LN who are refractory or intolerant to belimumab, while eculizumab is suggested for those with LN and thrombotic microangiopathy.

Key learning: The updated SER guidelines offer clear, actionable guidance on BT use in patients with SLE across manifestations.