What can we learn from systemic lupus erythematosus pathophysiology to improve current therapy?

Abstract

Systemic lupus erythematosus is an autoimmune disorder that can affect every organ system and cause a wide range of signs and symptoms. The precise pathogenic mechanism of disease remains uncertain, but it is clearly complex and involves the activation and deregulation of many components of the immune system. Certain well-characterized patterns of immune pathology are shared by a significant subset of patients and selective targeting of one or more of the key immune system molecules offers the prospect of more effective treatment. This review addresses the current and future treatment for patients with lupus, going from the lessons learnt with pathophysiologic studies to recent clinical trials with biological agents.

Keywords:

• biological drugs
• pathophysiology
• systemic lupus erythematosus

Financial & competing interests disclosure

Professor Isenberg has acted as a consultant for Eli-Lilly, UCB Pharma, GSK and Roche. His honoraria are passed onto a local arthritis charity. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• A better understanding, although it is far from complete, of the etiopathogenesis, of systemic lupus erythematosus has lead to the development of several new approaches to systemic lupus erythematosus treatment.

• So far, drugs that target the B cell seem to be the most promising.

• Belimumab, which blocks the B lymphocyte stimulator, has been approved by the US FDA, the first time a new lupus treatment has achieved this status in 50 years.

• Although large trial confirmation is awaited, rituximab (anti-CD20) and epratuzumab have shown promise.

• Other approaches for example anti-interferon are still being explored.

Notes