Earlier treatment with biologics to reduce the risk of organ damage Save
Sponsored by GSK US Medical Affairs
Learn about the importance of reducing organ damage and corticosteroid-associated toxicity in SLE, and how biologics may help to change the course of the disease by targeting its underlying mechanisms.
Transcription
Welcome to this podcast from GSK Lupus Educators Network. The Lupus Educators Network is a collaboration between GSK and a number of expert rheumatologists and nephrologists to discuss current opinions and experiences on some of the major topics and challenges of lupus care. It is sponsored by GSK. This information is scientific and non promotional in nature intended for US healthcare professionals only. This podcast represents the opinions and experiences of the speaker and may not represent the views of GSK.
Today we are delighted to be joined by Doctor. Narinder Anna Peretti, an associate professor of rheumatology at Vanderbilt University Medical Center and a director of lupus clinical trials and the Lupus Center at Vanderbilt. Doctor. Anna Peretti is a health care professional and paid consultant to GSK at the time of recording. In this podcast, Doctor.
Anna Paretti will discuss his views on the principles and implications of the twenty twenty three EULAR recommendations for the management of SLE. This podcast discusses the key recommendation highlights, but not the totality of the EULAR recommendations. For the full recommendations, please visit the 2023 publication. Additionally, please refer to the EULAR task force disclosure details, funding, and competing interests found in the publication.
Hi. I'm Narendra Afridi. I'm an associate professor of RheumDollgy at Vanderbilt University Medical Center, and I direct our lupus clinical trials and the lupus center here. My disclosures, I'm a consultant for GSK, the educators program. Just going over the overall principles of the 2023 EULAR recommendations, this is the first update of the EULAR recommendations since 2019 with, novel recommendations resulting from evolving body of evidence surrounding lupus and lupus nephritis treatments, notably the effectiveness of biologics and calcineurin inhibitors.
In total, there are five overarching principles for the management of lupus, which are underpinned by individualized and multidisciplinary care: early diagnosis, screening for organ involvement, prompt initiation of treatment, aiming at remission, and treatment adherence are identified as pillars of lupus management. Non pharmacological interventions to improve long term outcomes include sun protection, smoking cessation, healthy balanced diet, regular exercise, and measures to promote bone health. Individualized approaches to pharmacological intervention should consider patient characteristics such as race and ethnicity, socioeconomic factors, type and severity of organ involvement, treatment toxicities, comorbidities, and risk for organ damage progression alongside patient preference. There's also an emphasis on shared decision making and a trusting physician patient relationship, which are important for minimizing non adherence to treatment. So how might the twenty twenty three recommendations impact routine clinical practice?
The first big section is probably on disease activity and organ damage, and the twenty twenty three recommendations suggest assessment of disease activity at every visit using validated instruments such as the SLE disease activity, the SLEDAI, or the British Isles Lupus Assessment Group, the BiLag Index, to inform treatment decisions. There is a more defined monitoring frequency than previous EULAR recommendations, which could vary from every week in, for example, a lupus nephritis patient to every six months in more stable patients. Physicians should recognize the prognostic value of annual assessment of organ damage accrual using a validated measure such as the SLCACAIR Damage Index, the SDI. Similarly, the importance of vigilant monitoring for new organ involvement, particularly lupus nephritis, is emphasized due to the prognostic implications of delayed lupus nephritis diagnosis. In terms of treatment target, the twenty twenty three recommendations encourage adoption of treatment targets such as remission, which is the DORIS criteria, the definition of remission in SLE, or the low lupus disease activity state, the LLDAS.
The twenty twenty three recommendations also reinforce that minimization of corticosteroids is crucial, reflecting the organ damage accrual associated with chronic corticosteroid use. The updated recommendations are that corticosteroids should ideally be used only as a bridge therapy at the lowest possible dose for the shortest possible period and withdrawn when possible. And the recommendations also change the acceptable maintenance dose, which has been reduced from less than or equal to seven point five milligrams per day prednisone equivalent to less than or equal to five milligrams per day. All patients should receive antimalarials with individualized care based on FLAIR and retinal toxicity risk unless contraindicated, and conventional immunosuppressants or biologics should be considered if antimalarials alone are not sufficient to control disease activity, or if a patient is unable to reduce glucocorticoids below doses acceptable for chronic use. Notably, use of conventional immunosuppressant is not required before using a biologic.
So what would these recommendations mean for patients? The importance of patient preference and the choice of which pharmacological treatment, shared decision making and a trusting patient physician relationship is emphasized in 2023 recommendation, particularly in minimizing the risk of treatment noninherence, as this is a major cause of treatment failure and is associated with higher risk of flares and poor outcomes. And patient education about potential pharmacological and non pharmacological intervention allow patients to drive their own treatment journey and tailor it to what best suits their needs. Early diagnosis of lupus and associated organ damage is still an unmet patient need, as recent studies support that patients are still experiencing a median diagnostic delay of up to two years from onset of symptoms. Avoiding those diagnostic delays can help to reduce the likelihood of flare and hospitalization later down the line.
One of the important things is how would this factor in with discussions with patients, and I think one of the big things to emphasize is that corticosteroids should be used as a bridging therapy at the lowest possible dose for the shortest possible duration and trying to wean them off steroids when possible. And I think emphasizing that the more definitive treatment for lupus is use of immunosuppressants or biologics, and having the concepts introduced to the patients early on so that they're more familiar with the medications and involving them in the shared vision making early on during the course of their diagnosis can help patients be better prepared to go on these medications, and also help reduce the side effects from long term corticosteroid use and reduce damage in the long term. In summary, early and effective intervention along with strict treatment adherence are crucial components of the twenty twenty three EULA recommendations for lupus to reduce the risk for organ damage accrual, which is a recognized risk factor for early mortality and reduced quality of life. And a strong and collaborative relationship between patient and physician can help reduce the risk of treatment non adherence and give patients the best chance of positive outcomes.
Thank you for listening to this podcast, and hopefully this helps you be more familiar with the twenty twenty three EULAR recommendations and implementing them in clinical practice.
Today we are delighted to be joined by Doctor. Narinder Anna Peretti, an associate professor of rheumatology at Vanderbilt University Medical Center and a director of lupus clinical trials and the Lupus Center at Vanderbilt. Doctor. Anna Peretti is a health care professional and paid consultant to GSK at the time of recording. In this podcast, Doctor.
Anna Paretti will discuss his views on the principles and implications of the twenty twenty three EULAR recommendations for the management of SLE. This podcast discusses the key recommendation highlights, but not the totality of the EULAR recommendations. For the full recommendations, please visit the 2023 publication. Additionally, please refer to the EULAR task force disclosure details, funding, and competing interests found in the publication.
Hi. I'm Narendra Afridi. I'm an associate professor of RheumDollgy at Vanderbilt University Medical Center, and I direct our lupus clinical trials and the lupus center here. My disclosures, I'm a consultant for GSK, the educators program. Just going over the overall principles of the 2023 EULAR recommendations, this is the first update of the EULAR recommendations since 2019 with, novel recommendations resulting from evolving body of evidence surrounding lupus and lupus nephritis treatments, notably the effectiveness of biologics and calcineurin inhibitors.
In total, there are five overarching principles for the management of lupus, which are underpinned by individualized and multidisciplinary care: early diagnosis, screening for organ involvement, prompt initiation of treatment, aiming at remission, and treatment adherence are identified as pillars of lupus management. Non pharmacological interventions to improve long term outcomes include sun protection, smoking cessation, healthy balanced diet, regular exercise, and measures to promote bone health. Individualized approaches to pharmacological intervention should consider patient characteristics such as race and ethnicity, socioeconomic factors, type and severity of organ involvement, treatment toxicities, comorbidities, and risk for organ damage progression alongside patient preference. There's also an emphasis on shared decision making and a trusting physician patient relationship, which are important for minimizing non adherence to treatment. So how might the twenty twenty three recommendations impact routine clinical practice?
The first big section is probably on disease activity and organ damage, and the twenty twenty three recommendations suggest assessment of disease activity at every visit using validated instruments such as the SLE disease activity, the SLEDAI, or the British Isles Lupus Assessment Group, the BiLag Index, to inform treatment decisions. There is a more defined monitoring frequency than previous EULAR recommendations, which could vary from every week in, for example, a lupus nephritis patient to every six months in more stable patients. Physicians should recognize the prognostic value of annual assessment of organ damage accrual using a validated measure such as the SLCACAIR Damage Index, the SDI. Similarly, the importance of vigilant monitoring for new organ involvement, particularly lupus nephritis, is emphasized due to the prognostic implications of delayed lupus nephritis diagnosis. In terms of treatment target, the twenty twenty three recommendations encourage adoption of treatment targets such as remission, which is the DORIS criteria, the definition of remission in SLE, or the low lupus disease activity state, the LLDAS.
The twenty twenty three recommendations also reinforce that minimization of corticosteroids is crucial, reflecting the organ damage accrual associated with chronic corticosteroid use. The updated recommendations are that corticosteroids should ideally be used only as a bridge therapy at the lowest possible dose for the shortest possible period and withdrawn when possible. And the recommendations also change the acceptable maintenance dose, which has been reduced from less than or equal to seven point five milligrams per day prednisone equivalent to less than or equal to five milligrams per day. All patients should receive antimalarials with individualized care based on FLAIR and retinal toxicity risk unless contraindicated, and conventional immunosuppressants or biologics should be considered if antimalarials alone are not sufficient to control disease activity, or if a patient is unable to reduce glucocorticoids below doses acceptable for chronic use. Notably, use of conventional immunosuppressant is not required before using a biologic.
So what would these recommendations mean for patients? The importance of patient preference and the choice of which pharmacological treatment, shared decision making and a trusting patient physician relationship is emphasized in 2023 recommendation, particularly in minimizing the risk of treatment noninherence, as this is a major cause of treatment failure and is associated with higher risk of flares and poor outcomes. And patient education about potential pharmacological and non pharmacological intervention allow patients to drive their own treatment journey and tailor it to what best suits their needs. Early diagnosis of lupus and associated organ damage is still an unmet patient need, as recent studies support that patients are still experiencing a median diagnostic delay of up to two years from onset of symptoms. Avoiding those diagnostic delays can help to reduce the likelihood of flare and hospitalization later down the line.
One of the important things is how would this factor in with discussions with patients, and I think one of the big things to emphasize is that corticosteroids should be used as a bridging therapy at the lowest possible dose for the shortest possible duration and trying to wean them off steroids when possible. And I think emphasizing that the more definitive treatment for lupus is use of immunosuppressants or biologics, and having the concepts introduced to the patients early on so that they're more familiar with the medications and involving them in the shared vision making early on during the course of their diagnosis can help patients be better prepared to go on these medications, and also help reduce the side effects from long term corticosteroid use and reduce damage in the long term. In summary, early and effective intervention along with strict treatment adherence are crucial components of the twenty twenty three EULA recommendations for lupus to reduce the risk for organ damage accrual, which is a recognized risk factor for early mortality and reduced quality of life. And a strong and collaborative relationship between patient and physician can help reduce the risk of treatment non adherence and give patients the best chance of positive outcomes.
Thank you for listening to this podcast, and hopefully this helps you be more familiar with the twenty twenty three EULAR recommendations and implementing them in clinical practice.
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