Antonis Fanouriakis, Myrto Kostopoulou, Hans-Joachim Anders, Jeanette Andersen, Martin Aringer, Michael W Beresford, Andrea Doria, Eleni Frangou, Richard Furie, Dafna D Gladman, Frederic Houssiau, Alexandre Karras, Marios Kouloumas, Anastasia-Vasiliki Madenidou, Ana Malvar, Smaragdi Marinaki, Chi Chiu Mok, Gabriella Moroni, Ioannis Parodis, Simona Rednic, Cristiana Sieiro Santos, Carlo Alberto Scire, Josef S Smolen, Farah Tamirou, Yoshiya Tanaka, Y K Onno Teng, Elisabet Welin, George Bertsias, Dimitrios T Boumpas
{"title":"EULAR recommendations for the management of systemic lupus erythematosus with kidney involvement: 2025 update.","authors":"Antonis Fanouriakis, Myrto Kostopoulou, Hans-Joachim Anders, Jeanette Andersen, Martin Aringer, Michael W Beresford, Andrea Doria, Eleni Frangou, Richard Furie, Dafna D Gladman, Frederic Houssiau, Alexandre Karras, Marios Kouloumas, Anastasia-Vasiliki Madenidou, Ana Malvar, Smaragdi Marinaki, Chi Chiu Mok, Gabriella Moroni, Ioannis Parodis, Simona Rednic, Cristiana Sieiro Santos, Carlo Alberto Scire, Josef S Smolen, Farah Tamirou, Yoshiya Tanaka, Y K Onno Teng, Elisabet Welin, George Bertsias, Dimitrios T Boumpas","doi":"10.1016/j.ard.2025.09.007","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this study was to update the 2019 European Alliance of Associations for Rheumatology (EULAR)/ European Renal Association/European Dialysis Transplantation Association (ERA-EDTA) recommendations for the management of systemic lupus erythematosus (SLE) with kidney involvement, taking into consideration emerging evidence and recent developments in the field.</p><p><strong>Methods: </strong>We recruited an international Task Force of experts and followed the EULAR standard operating procedures. We performed systematic literature research (period January 2019 to March 2024), followed by the modified Delphi method, to form questions, elicit expert opinions, and reach consensus. The new evidence was examined, taking into consideration previous updates.</p><p><strong>Results: </strong>The Task Force agreed on 4 overarching principles and 13 recommendations, which were also evaluated for their feasibility and impact on clinical care. These concern the use of kidney biopsy for diagnosis; targets of therapy and treatment milestones; immunomodulatory therapy with antimalarials, glucocorticoids, immunosuppressives (mycophenolate, cyclophosphamide, and calcineurin inhibitors), and biologics (belimumab, obinutuzumab, and rituximab); nonimmune therapy (kidney protection, vaccinations, cardiovascular, and bone protection); family planning; and management of kidney failure. Guidance on single-agent or early combination immune therapy, glucocorticoid tapering and withdrawal, duration of immune therapy, and treatment of refractory disease is provided.</p><p><strong>Conclusions: </strong>The updated EULAR recommendations provide evidence- and expert-based consensus on the management of SLE with kidney involvement, adjusted for severity, and taking into consideration long-term efficacy, safety, cost, and local availability of drugs.</p>","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":""},"PeriodicalIF":20.6000,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of the Rheumatic Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.ard.2025.09.007","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RHEUMATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives: The objective of this study was to update the 2019 European Alliance of Associations for Rheumatology (EULAR)/ European Renal Association/European Dialysis Transplantation Association (ERA-EDTA) recommendations for the management of systemic lupus erythematosus (SLE) with kidney involvement, taking into consideration emerging evidence and recent developments in the field.
Methods: We recruited an international Task Force of experts and followed the EULAR standard operating procedures. We performed systematic literature research (period January 2019 to March 2024), followed by the modified Delphi method, to form questions, elicit expert opinions, and reach consensus. The new evidence was examined, taking into consideration previous updates.
Results: The Task Force agreed on 4 overarching principles and 13 recommendations, which were also evaluated for their feasibility and impact on clinical care. These concern the use of kidney biopsy for diagnosis; targets of therapy and treatment milestones; immunomodulatory therapy with antimalarials, glucocorticoids, immunosuppressives (mycophenolate, cyclophosphamide, and calcineurin inhibitors), and biologics (belimumab, obinutuzumab, and rituximab); nonimmune therapy (kidney protection, vaccinations, cardiovascular, and bone protection); family planning; and management of kidney failure. Guidance on single-agent or early combination immune therapy, glucocorticoid tapering and withdrawal, duration of immune therapy, and treatment of refractory disease is provided.
Conclusions: The updated EULAR recommendations provide evidence- and expert-based consensus on the management of SLE with kidney involvement, adjusted for severity, and taking into consideration long-term efficacy, safety, cost, and local availability of drugs.
期刊介绍：
Annals of the Rheumatic Diseases (ARD) is an international peer-reviewed journal covering all aspects of rheumatology, which includes the full spectrum of musculoskeletal conditions, arthritic disease, and connective tissue disorders. ARD publishes basic, clinical, and translational scientific research, including the most important recommendations for the management of various conditions.
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