Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune multisystem disease with a variable presentation and manifestations ranging from mild to severe or even life-threatening. There is an ongoing and unmet need for novel, disease-specific, effective and safe treatment modalities. The aim of this review is to summarize data on SLE treatment that have emerged over the last 3 years. We will put emphasis on studies evaluating potential treatments on severe lupus manifestations such as lupus nephritis. Despite the existence of several therapeutic agents in SLE, the disease keeps causing significant morbidity. It is encouraging that a variety of therapeutic options are currently under investigation, although there are occasional trial failures.
Highlights
Systemic lupus erythematosus (SLE) is an astonishing heterogeneous multisystem autoimmune disease with a quite unpredictable outcome
Rituximab (RTX) causing B cell depletion can be administered according to the ACR and EULAR guidelines in refractory lupus nephritis despite failed clinical trials, and is often used off-label for other manifestations as well, based on the encouraging results of diverse studies
These data suggest that introduction of the novel calcineurin inhibitor voclosporin and the low-dose regimen along with standard treatment for induction therapy of active lupus nephritis is more efficacious than mycophenolate mofetil (MMF) and corticosteroids alone
Summary
Systemic lupus erythematosus (SLE) is an astonishing heterogeneous multisystem autoimmune disease with a quite unpredictable outcome. Rituximab (RTX) causing B cell depletion can be administered according to the ACR and EULAR guidelines in refractory lupus nephritis despite failed clinical trials, and is often used off-label for other manifestations as well, based on the encouraging results of diverse studies. This reflects one of the problems of failed clinical trials in patients with SLE: failure to suppress one specific SLE manifestation, such as lupus nephritis, may not exclude encouraging outcomes for some other aspects of the disease, such as hematological, mucocutaneous, or articular involvement.
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