Icon: Silhouette highlighting organ domains


Consider adding biologics, such as BENLYSTA (belimumab) or anifrolumab, after HCQ:

  • If not responding to HCQ (alone or in combination with GC)
  • Or, unable to taper steroids below doses acceptable for chronic use
Icon: Steroids


Maintenance steroid dose should be ≤5 mg/day and, when possible, withdrawn

Icon: Kidneys


Consider addition of BENLYSTA or CNIs at the beginning of treatment for ALL patients with active proliferative lupus nephritis

Following renal response, continue treatment for at least 3 years

These are selected recommendations, not the complete EULAR recommendations.

BENLYSTA was acknowledged to have more than 10 years of real-life experience

According to EULAR, prior use of a conventional immunosuppressive drug should not be mandatory for initiating a biologic.

According to EULAR, changes in the treatment landscape have inspired discussions on a “paradigm shift” in the treatment of lupus nephritis, moving from the traditional “induction-maintenance” regimen to the early use of combination therapies.

Overarching Principles from the EULAR 2023 Recommendations


CNI = calcineurin inhibitor; EULAR = European Alliance of Associations for Rheumatology; GC = glucocorticoid; HCQ = hydroxychloroquine; SLE = systemic lupus erythematosus.

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Used with permission from Fanouriakis A, et al. Ann Rheum Dis. 2023;0:1-15. ©BMJ