Novel therapeutic biologic agents for systemic lupus erythematosus
The last significant breakthrough in the treatment of systemic lupus erythematosus (SLE) was the use of
cyclophosphamide and methylprednisolone in the treatment of systemic lupus erythematosus. Recent advances in immunology, oncology, and endocrinology have resulted in many potential therapies for SLE. These therapies include new immunosuppressants, biologic medications, tolerizing agents, immunoablation techniques, and hormonal medications. Some therapies are currently in use in clinical practice (mycophenolate mofetil) and others are entering phase trials (anti-BLyS monoclonal antibody).
Owing to their ability to promote the onset and flares of systemic lupus erythematosus (SLE), B-cells are now established as key players in the pathogenesis of the disease, and, therefore, have become a major therapeutic focus in SLE.New therapeutic approaches are focused on B-cell targets, T-cell downregulation and co-stimulatory blockade, cytokine inhibition, and the modulation of complement. Several biological agents have been developed, but this encouraging news is associated with several disappointments in trials and provide a timely moment to reflect on biologic therapy in SLE.. In this article, we review the literature on B-celldirected therapies for SLE focusing on B-cell depletion, Bcell tolerance, costimulatory signals, and cytokines that affect B-cell survival and activation.