Over what timeline do you typically try to escalate your LN patients to triple therapy?
The new recommendation is "Early Quadruple Therapy" per the 2025 EULAR Lupus Nephritis Guidelines announced during a presentation at EULAR 2025 by Dr. Dimitrios Boumpos.
Kudos to EULAR! They recommend this to:
- increase remission rates
- reduce the need for steroids with these steroid-sparing agents
- red...
I pulse with steroids and then start them on 40mg prednisone equivalent a day. At the same time, I will start them on a mycophenolate analog and increase the dose every two weeks as tolerated until they are at between 2-3 g/d. I will also initiate therapy with belimumab and/or CNI, but in reality, t...
Similar to Dr. @Dr. First Last, I start triple therapy in almost everyone (except for those at the lowest risk for progression to ESRD). It warms my heart to see that over 60% of respondents said the same thing, and I hope it keeps growing quickly.
Why should we start with triple therapy?
- 20% of LN p...
More and more, I am starting patients on a triple therapy and not using the stepped approach. In general, our group uses glucocorticoids at reduced doses, MMF at reduced doses, and voclosporin (or a CNI). The rationale is to get the proteinuria under control quickly, protect the podocyte from ongoin...