Lupus Management At EULAR 2020 - Dr. Kathryn Dao Save
Dr. Kathryn Dao highlights SLE presentations from virtual EULAR 2020 meeting June 3-6, 2020
- HCQ levels predicts VTE
- Can you withdraw MMF in stable SLE patients?
-Updated EULAR Lupus Treatment guidelines
Transcription
This is doctor Katherine Dow reporting for RheumNow. It's been a great day. EULAR day two. There's a lot of information about lupus. So I wanna share with you what I learned today.
The first one was a study done by doctor Michelle Petrie. She wanted to know whether or not hydroxychloroquine blood levels can predict venothrombolic events in lupus. She studied, prospectively, the Hopkins lupus cohort. And, yes, she did find that low blood levels actually are associated with higher rates of venothrombolic events. And so she says, you know, don't worry about this whole conflict between us and the ophthalmologist.
You treat the patient with five milligrams per kilograms a day of hydroxychloroquine or six point five milligrams per kilograms a day. Just draw their blood. Figure out what their levels are. The goal levels should be between one thousand to fifteen hundred nanograms per milliliters. The second study is something that I've been waiting for for a long time.
What do you do with your patients who have quiescent lupus and are on mycophenolate? Do you stop the mycophenolate or do you continue it? So this is a prospective randomized control trial. It's not blinded. And what they did was they took a group of lupus patients who are on mycophenolate and randomized them to continue the therapy or to stop the therapy.
Okay? So they tapered them over a period of twelve weeks and followed them for sixty weeks. The majority of these patients were on mycophenolate because of lupus nephritis. Many of them have been on mycophenolate for six years or more, and over fifty percent of them actually had a positive double stranded DNA, and twenty five percent of them had low complements. So what they found in their results was that patients who stopped mycophenolate didn't have more flares compared to patients who continued it.
They measured the sleep day. They measured the bileag. They measured a bunch of different lupus disease activity markers, and they didn't find much of a difference. What they did find was that, with mycophenolate, if it's continued, there is a little bit higher risk for infections. So there you have it, folks.
You can stop mycophenolate in a patient who had been quiescent of their lupus for a while. And then the third presentation was actually the updated lupus nephritis guidelines by EULAR and the ERA EDTA group. So the last time that the guidelines were updated was back in 2012. So what do the guidelines now say? They really want you to treat to target.
So what that means is that they want you to have the patients achieve twenty five percent improvement in their urine proteinuria at month three, fifty percent improvement of the proteinuria by month six, and complete remission, renal remission, that is, by one year. They says that for lupus nephritis, Class IIIIV, with or without Class V, you can use mycophenolate, cyclophosphamide with the urolupus protocol preferred or the NIH protocol, or you can use mycophenolate with a casinurin inhibitor. They also want you to kind of minimize steroids. So the goal dose should be seven point five milligrams a day at month six. And then the third thing is for maintaining remission, they recommend using either mycophenolate or azathioprine.
So there you have it. Lupus, lupus, lupus. What a great day.
The first one was a study done by doctor Michelle Petrie. She wanted to know whether or not hydroxychloroquine blood levels can predict venothrombolic events in lupus. She studied, prospectively, the Hopkins lupus cohort. And, yes, she did find that low blood levels actually are associated with higher rates of venothrombolic events. And so she says, you know, don't worry about this whole conflict between us and the ophthalmologist.
You treat the patient with five milligrams per kilograms a day of hydroxychloroquine or six point five milligrams per kilograms a day. Just draw their blood. Figure out what their levels are. The goal levels should be between one thousand to fifteen hundred nanograms per milliliters. The second study is something that I've been waiting for for a long time.
What do you do with your patients who have quiescent lupus and are on mycophenolate? Do you stop the mycophenolate or do you continue it? So this is a prospective randomized control trial. It's not blinded. And what they did was they took a group of lupus patients who are on mycophenolate and randomized them to continue the therapy or to stop the therapy.
Okay? So they tapered them over a period of twelve weeks and followed them for sixty weeks. The majority of these patients were on mycophenolate because of lupus nephritis. Many of them have been on mycophenolate for six years or more, and over fifty percent of them actually had a positive double stranded DNA, and twenty five percent of them had low complements. So what they found in their results was that patients who stopped mycophenolate didn't have more flares compared to patients who continued it.
They measured the sleep day. They measured the bileag. They measured a bunch of different lupus disease activity markers, and they didn't find much of a difference. What they did find was that, with mycophenolate, if it's continued, there is a little bit higher risk for infections. So there you have it, folks.
You can stop mycophenolate in a patient who had been quiescent of their lupus for a while. And then the third presentation was actually the updated lupus nephritis guidelines by EULAR and the ERA EDTA group. So the last time that the guidelines were updated was back in 2012. So what do the guidelines now say? They really want you to treat to target.
So what that means is that they want you to have the patients achieve twenty five percent improvement in their urine proteinuria at month three, fifty percent improvement of the proteinuria by month six, and complete remission, renal remission, that is, by one year. They says that for lupus nephritis, Class IIIIV, with or without Class V, you can use mycophenolate, cyclophosphamide with the urolupus protocol preferred or the NIH protocol, or you can use mycophenolate with a casinurin inhibitor. They also want you to kind of minimize steroids. So the goal dose should be seven point five milligrams a day at month six. And then the third thing is for maintaining remission, they recommend using either mycophenolate or azathioprine.
So there you have it. Lupus, lupus, lupus. What a great day.
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