Dr. Lisa R. Sammaritano, a leading expert in lupus at Weill Cornell Medicine, discusses the groundbreaking updates to the ACR Lupus Nephritis Guideline, a decade in the making. She shares insights on innovative treatment strategies, including combination therapies and the push to minimize glucocorticoid use for better patient outcomes. The conversation highlights the unique needs of both pediatric and adult patients, the promise of a triple therapy approach, and challenges in managing class 5 lupus nephritis, emphasizing the importance of individualized care.
The 2024 Lupus Nephritis Guidelines highlight a holistic approach and incorporate new FDA-approved therapies, significantly improving patient outcomes.
The guidelines advocate for a strategic shift towards triple therapy as the first-line treatment, emphasizing reduced glucocorticoid use to minimize toxicity.
Deep dives
Introduction of New Lupus Nephritis Guidelines
The 2024 American College of Rheumatology Lupus Nephritis Guidelines mark a significant update after a decade, incorporating advancements in therapies and a more holistic approach to patient management. The guidelines now reflect new FDA-approved treatments such as bulimumab and voclosporin, which demonstrate improved outcomes for lupus nephritis patients compared to outdated recommendations from 2012. Key outcomes from recent clinical studies have informed this update, underscoring the importance of integrating these innovative therapies into treatment plans. By acknowledging these changes, the new guidelines position healthcare providers to make more informed decisions about lupus nephritis management in clinical practice.
Inclusive Approach in Guideline Development
The development process for the new guidelines involved a diverse team of nearly 70 members, including experts in rheumatology, nephrology, and a patient panel representing individuals with lupus nephritis. This comprehensive collaboration ensured that the guidelines consider the specific challenges faced by different patient demographics, including pediatric and older patients. By involving pediatric rheumatologists and patients in the decision-making process, the guidelines now include tailored recommendations for these groups, addressing their unique needs in treatment. This inclusive approach aims to enhance the quality of care and optimize outcomes for all patients with lupus nephritis, regardless of age.
Emphasis on Combination Therapy and Minimization of Glucocorticoids
The updated guidelines advocate for a shift towards triple therapy as the first-line treatment for class 3 and 4 lupus nephritis, emphasizing the benefits of combining glucocorticoids with mycophenolate or cyclophosphamide, and either bulimumab or a calcineurin inhibitor. This new treatment framework highlights the importance of minimizing glucocorticoid usage to mitigate toxicity while effectively managing lupus nephritis. Specific protocols advocate for pulse glucocorticoids followed by a lower oral taper, targeting a dose of 5 mg or less over six months, significantly reducing potential side effects of long-term glucocorticoid therapy. This strategic approach allows for better patient outcomes, as evidenced by discussions within the guidelines on the considerations for selecting the most appropriate therapy based on individual patient profiles.
We are proud to present the highly anticipated “ACR 2024 Lupus Nephritis Guideline” with First Author and frequent guest, Dr. Lisa R. Sammaritano. A decade in the making, we reflect on the significant advancements in available therapies, the guideline’s holistic approach to managing Lupus Nephritis (LN) across all age groups, and include insights on combination therapies, minimizing glucocorticoid use and how to manage the full spectrum of patients with Lupus Nephritis.
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