I17 Choosing wisely: which biological should we use in which patient?

Two biologicals, belimumab and anifrolumab, are currently approved for use in SLE, and are therefore supported by extensive phase 3 clinical trials, while some others are supported by more limited data but may be used off-label. For the clinician an important practical question is which biological to choose for the individual in whom a biological is, indeed, needed to control the disease and achieve better outcomes. Important considerations to guide such choices are: for belimumab, anti-DNA (+) status and low complement indicate a greater treatment effect for anifrolumab, specific benefits with respect to cutaneous manifestations of SLE have been demonstrated no other subsets of patients have been identified as particularly likely to respond to these two biologicals, but some subsets may be less likely to benefit belimumab is approved for both SLE in general and for lupus nephritis, and for use in pediatric patients the side effect profiles of belimumab and anifrolumab are dissimilar and may therefore guide treatment choice in individual cases the search for better biomarkers to guide therapy continues off-label biologicals such as rituximab and tocilizumab are supported by inconsistent data that leave important questions unanswered; they are most often used in a 'back-against-the-wall' situation.