Update to the Sociedad Española de Reumatología Guidelines on the Use of Biological Therapy in Systemic Lupus...

The significant growth of information in the field of biological therapies (BT) for the treatment of systemic lupus erythematosus (SLE) has made it necessary to update the previous SER recommendation document. Three BTs have been approved for use in SLE. The first BT available was belimumab, with an already abundant and solid body of evidence regarding its efficacy and safety. More recently, anifrolumab was added, also backed by a robust body of evidence but with less experience of practical application. Finally, the emergence of obinutuzumab, a second-generation anti-CD20 monoclonal antibody that is more effective than rituximab and has demonstrated efficacy in lupus nephritis, has revitalised ablative therapy in SLE, although more safety data is needed before it can widely replace rituximab. Despite the lack of direct comparisons between the various biological agents available, certain differences regarding their efficacy across different disease domains, as well as in the speed of action and safety-related aspects, must be taken into account when tailoring treatment decisions. Overall, biologics have been increasingly incorporated into the treatment algorithm at earlier stages of SLE, based on their ability to improve outcomes compared to standard therapy, and are now first-line treatments for certain manifestations such as lupus nephritis.