How would you treat active SLE with high level crithidia dsDNA abs and recurrent pleuritis with effusions still requiring corticosteroids despite combination therapy with full doses of mycophenolate, hydroxychloroquine, and Benlysta for over 6 months after no response to Saphnelo for 6 months?

Assuming verified adherence with optimal blood levels of mycophenolate and hydroxychloroquine

Answer from: at Academic Institution

There are no controlled trials of different therapies for treating refractory pleuritis in lupus as the primary manifestation. Due to refractory pleuritis being relatively uncommon, the trials of benlysta and anifrolumab did not have enough patients to assess response. In the literature, there are a...

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at Hackensack University Medical Center
I agree with the posted answers by @Donald E. Thom...

Answer from: at Community Practice

To add to Dr. @Gary Gilkeson's excellent answer:Treatment-resistant, recurrent pleural effusions after such good combination therapies as these would be highly unusual. Though anti-dsDNA Crithidia is positive, this does not necessarily mean the effusions/pleuritis are due to SLE. I have patients wit...

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How would you treat active SLE with high level crithidia dsDNA abs and recurrent pleuritis with effusions still requiring corticosteroids despite combination therapy with full doses of mycophenolate, hydroxychloroquine, and Benlysta for over 6 months after no response to Saphnelo for 6 months?

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