Conference MDAngle: ACR 2024 Systemic Lupus Erythematosus/Lupus Nephritis

Conference MDAngle offers personal perspectives from conference attendees, showcasing their anticipation, quick takeaways, and insights into how the presented research will affect their patients.

The American College of Rheumatology Convergence 2024 was held from November 14 to 19, 2024, in Washington, DC. The meeting featured cutting-edge research on a variety of topics, including lupus and other rheumatic diseases. Key highlights included scientific sessions covering clinical and basic science, offering insights into new therapies and ongoing research, such as studies evaluating the efficacy and safety of monoclonal antibodies in the treatment of lupus nephritis and systemic lupus erythematosus. Attendees connected with peers and experts in networking lounges focused on specific areas of interest.

Anca D. Askanase, MD, MPH

Professor of Medicine; Director, Lupus Center, Columbia University Irving Medical Center, New York, NY

“It feels that this ACR may be the beginning of a new era in better defining therapeutic outcomes. We have now defined lupus low disease activity and remission, and we're even considering remission off treatment and cure, things that even a couple of years ago we would not have dared to dream of but seem to be in the realm of possibility.”

Bella Mehta, MD, MS

Assistant Professor, Department of Rheumatology, Weill Cornell Medicine; Attending Physician, Department of Rheumatology, Hospital for Special Surgery, New York, NY

“I just got back from the ACR Convergence this year, and I think the big takeaway was the new guidelines for lupus nephritis. These guidelines are different from what we were doing in clinical practice.”

Preconference Considerations

ACR 2024: Promising Advances in Lupus Nephritis and SLE

Dr Askanase notes the excitement building around ACR 2024, with positive phase 3 trial results for obinutuzumab in lupus nephritis and dapirolizumab in systemic lupus erythematosus. Attendees can also expect the unveiling of new lupus nephritis guidelines developed over the past year and insights into the potential of cell therapies, including CAR T-cell treatment. This conference marks a significant moment in lupus research, as discussions will focus on achieving low disease activity, remission, and the possibility of long-term drug-free cures.

Quick Clinical Takeaways

ACR 2024: A Review of Updated Lupus Nephritis Guidelines

Dr Mehta comments on how new guidelines for lupus nephritis emphasize more frequent monitoring, with proteinuria checks every 3-6 months for patients with known nephritis and every 6-12 months for those without. On the basis of results from the BLISS-LN and AURORA 1 trials, they recommend triple therapy (glucocorticoids, mycophenolate analogs, and either belimumab or calcineurin inhibitors) as the primary treatment while minimizing steroid use. Kidney biopsy is stressed for diagnosis and monitoring, and treatment adjustments, including options such as rituximab, are recommended for refractory cases.

How Will My Patients Benefit?

ACR 2024: Clinical Impact of Lupus Nephritis Guidelines

Dr Askanase emphasizes the significance of the 2024 ACR guidelines for lupus nephritis which recommend triple therapy — corticosteroids, mycophenolate, and a calcineurin inhibitor or belimumab — for class 3, 4, or 5 lupus nephritis. On the basis of recent trials, these guidelines highlight the importance of early use of advanced therapies to preserve kidney function, reduce proteinuria, and achieve steroid tapering to ≤ 5 mg, ideally within 6 months.

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Summary

The American College of Rheumatology Convergence 2024, held in Washington, DC, featured groundbreaking research on lupus and other rheumatic diseases. Key highlights included phase 3 trial results for obinutuzumab and dapirolizumab in lupus nephritis and systemic lupus erythematosus, as well as new lupus nephritis guidelines emphasizing triple therapy (corticosteroids, mycophenolate, and a calcineurin inhibitor or belimumab) for class 3, 4, or 5 disease. Dr Askanase and Dr Mehta discussed the importance of early advanced therapy, frequent monitoring of proteinuria, and the potential of CAR T-cell therapies. The meeting also focused on achieving low disease activity, remission, and the possibility of long-term drug-free cures for patients with lupus.

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