How Long Is Too Long? Maintenance Therapy for Patients With Lupus Nephritis

Drs. McMahon and Kalunian discuss how the latest lupus nephritis guidelines from the American College of Rheumatology and European Alliance of Associations for Rheumatology are shifting care from short-term, reactive treatment to longer-term, continuous maintenance—often 3 to 5 years or more—to better prevent kidney flares and preserve renal function. They highlight emerging data on biologic-based triple therapy (including belimumab); the importance of biomarkers and repeat biopsies; and the growing push toward personalized, sometimes indefinite, therapy for high‑risk patients.