New directions in the treatment of systemic lupus erythematosus
Kalunian K et al. – Biologic compounds that target specific immunologic mechanisms offer a new paradigm in the treatment of systemic lupus erythematosus (SLE); may reverse the course of the disease and might provide some new alternatives to reduce symptoms and limit tissue damage without undue contribution to overall morbidity and mortality.Methods- Review to provide an up-to-date overview of:
- Treatment approaches for SLE, highlighting the multiplicity and heterogeneity of clinical symptoms that underlie therapeutic decisions
- Currently available therapies, their mechanisms and associated side-effects
- Recent developments with biologic treatments including rituximab, epratuzumab, TNF inhibitors, and belimumab
- MEDLINE literature search for ‘SLE’ and ‘damage’ and ‘treatment’ was undertaken for 1996–2008
- Secondary citations obtained from selected manuscripts
- Individual case studies were excluded
Results- SLE is an autoimmune disease involving multiple organ systems, a clinical pattern of flares and remissions, and the presence of ANA
- Early symptoms involve skin and joints
- Disease morbidity and mortality are associated with CV events and damage to major organs, particularly the kidneys
- Many of the current therapeutic options are considered to be inadequate because of toxicities, organ damage, and insufficient control of disease
- New treatments are mainly focused on the targeted immunosuppressive actions provided by biologic therapy
- Although their long-term beneficial or harmful effects are unclear, their precise molecular targeting may advance the cause of individualized molecular medicine
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