Table 3.

Pharmacotherapy of renal and non-renal SLE (n = 147).

Questionnaire ItemsMode (% responders)Commonly Repeated Strategies (% responders)
Renal SLE
  Specialist performing routine treatment of nephritisNephrologist (88)Rheumatologist (60), other (6), immunologist (1), general internist (2)
  Most common agents used for induction of class 3 or 4 nephritis*CYC IV (50)MMF (39), oral CYC (7), AZA (3), RTX (0)
  Second-line choice if induction for lupus nephritis fails, n = 144MMF (33)10–30% responders: IV methylprednisolone pulse (28), CYC IV (28), 10% of responders: RTX (6), oral CYC (3), AZA (3)
Non-renal SLE
  Most commonly used medications in the treatment of non-renal SLEHCQ (99)75–99% responders: oral steroids (97), NSAID (97), MTX (93), azathioprine (93), MMF (82). 11–75% responders: IV steroids (75), CYC (65), chloroquine (61), RTX (53), IVIG (48), belimumab (43), LEF (38), SSZ (27), ABA (17). ≤ 10%: quinacrine (10), thalidomide (10), TNF inhibitors (8), other (8)
  % SLE patients taking antimalarials (chloroquine, HCQ)81–100% patients (67)61–80% (25), 41–60% (5), 2140% (2), 11–20% (1), 0–10% (0)
  % SLE patients requiring minimum low-dose prednisone indefinitely6–10% (26)11–20% (24), 41–60% (17), 21–40% (11), 0–5% (11), 61–80% (5), 81–100% (3), have no idea (3)
  Discontinuation of antimalarials in stable SLE patients#No (79)Yes (16), other (7), I do not know (3)
  Adjustment of immunosuppression in stable SLE patientsYes (65)Sometimes (31), no (2), other (1)
  Discontinuation of immunosuppression in stable SLE patientsDepends on the extent of SLE disease/damage overall (55)Yes (29), depend on the agent(s) used (26), no (13), I do not know (4), other (3)
  Used belimumab in the treatment of patients with active SLENo (67)Yes (25), sometimes (5), other (2)
  • * In addition to high-dose steroids.

  • # Discontinuation of antimalarials in patients with stable SLE who have been taking the medication for a prolonged period and continue in remission.

  • Adjustment of immunosuppression to facilitate steroid taper and discontinuation in a stable SLE patient with low disease activity requiring < 10 mg oral daily steroid.

  • Discontinuation of immunosuppression in patient with SLE who achieved and maintained remission while taking steroid-sparing agent for a prolonged period. SLE: systemic lupus erythematosus; MMF: mycophenolate mofetil; RTX: rituximab; HCQ: hydroxychloroquine; AZA: azathioprine; CYC: cyclophosphamide; LEF: leflunomide; ABA: abatacept; NSAID: nonsteroidal antiinflammatory drug; MTX: methotrexate; SSZ: sulfasalazine; TNF: tumor necrosis factor; IV: intravenous.