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New directions in the treatment of systemic lupus erythematosus
Current Medical Research and Opinion, 07/01/09

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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