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Management of Systemic Lupus Erythematosus

that is no worse than 20% below the pre-flare value or ≤60 mL/min/
1.73 m and no rescue therapy for treatment failure) at week 104. 85, level I
2
8.2 Mucocutaneous

Topical agents (corticosteroids or CNIs) and HCQ are the mainstay
of treatment in CLE. Systemic corticosteroids may be considered in
moderate to severe CLE or when topical treatment is insufficient or not
practical. 23
In a Cochrane systematic review of 61 RCTs with interventions for CLE
showed: 86, level I
• HCQ was more effective than placebo in achieving partial clinical
response at 12 months although the difference was not significant
• HCQ was superior to placebo on reducing clinical flares at six
months (RR=0.49, 95% CI 0.28 to 0.89)
• MTX was superior to placebo in achieving complete clinical
response at six months (RR=3.57, 95% CI 1.63 to 7.84)
• MTX led to fewer flares compared with placebo at 12 months,
however it was not significant
• no difference between AZA and ciclosporin in complete clinical
response at 12 months
Based on GRADE, the body of evidence was of moderate to low quality.
8.3 Neuropsychiatry

Treatment of NPSLE is determined by the underlying pathophysiology i.e.
inflammatory or thrombotic. Corticosteroids and/or immunosuppressive
agents should be considered in the former, while anticoagulant/
antithrombotic treatment is favoured in the latter especially when aPLs
are present. 50
As mentioned earlier in Subchapter 6.2, two systematic reviews
showed that CYC in combination with corticosteroids was more effective
compared with corticosteroids alone in NPSLE. The treatments also
had a good safety profile. 68, level I; 70, level I

Anti-epileptics and anti-psychotics may be considered as adjunct
therapy when indicated.

8.4 Haematology

Haematological manifestations frequently requiring immunosuppressants
in SLE include thrombocytopenia and AIHA. First-line treatment of
significant lupus thrombocytopenia (platelet count below 30,000/
mm ) and AIHA consist of moderate/high doses of corticosteroids in
3
combination with immunosuppressants (AZA, MMF or ciclosporin). 50
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