Novel treatments for systemic lupus erythematosus

Abstract

There are many new therapeutic directions for the disease systemic lupus erythematosus (SLE). Despite this, the US Food and Drug Administration (FDA) has approved only one biological agent and it involves B cells, now thought to play a significant role in the pathogenesis of SLE. The name of the drug is belimumab, which is an agent that removes the B-cell cytokine called B lymphocyte stimulation factor (BLyS). Rituximab did not achieve its primary endpoints, even though the consensus is that it may be effective in some forms of SLE including renal disease. The anticytokine therapies against interleukin (IL)-6, IL-10, IL-17 and tumor necrosis factor (TNF) are effective in their own ways and phase II and III trials are in progress.Of particular interest to immunologists are the anti-interferon alpha and gamma drugs, which show promise in the animal models. Modulation of costimulatory molecules; specifically, the anti CD40, CTLA-Ig and ICOS/B7RP blockade agents offer possibilities for the future using new pathways heretofore limited to rheumatoid arthritis. Finally, the use of tyrosine kinase inhibitors is another direction that has been successful in the inhibition of SLE in the murine model; early trials in human SLE have begun.

If You Dont Put it in Your Mind, then it Dont Matter: A Phenomenological Study of Coping Self-Efficacy in African American Women Diagnosed with Lupus

“…The unique disease experiences and coping methods that African American lupus patients utilize further warrants contextualized and culturally competent programs in order to address the unique needs of this disparately affected population [26]. Specifically, the isolation African American with lupus expressed in the current study, coupled with their desire to interact with peers, lends further credibility to the utility of peer mentoring disease management programs in this population [58,59]. Increasing health related quality of life, through coping self-efficacy among African American women with lupus would help with its promotion within this ethnic/racial minority group as well as others.…”

Recent developments in the treatment of patients with systemic lupus erythematosus: focusing on biologic therapies

“…Co-stimulatory pathways include CD40/CD40L, CD28, (CTLA4), cytotoxic Tlymphocyte antigen 4 and CD80 (B7.1)/CD86 (B7.2) [57]. An open-labelled study evaluating anti CD40L antibodies in 28 patients with active proliferative LN showed significant reduction in proteinuria but had to be terminated due to thromboembolic events [58].…”

“…Moreover, ICOS amplified the ability of peripheral blood T cells to support the production of IgG anti-dsDNA antibody by autologous peripheral blood B cells. B7-related protein-1 (B7RP-1) is a B7-like molecule that binds to ICOS and is expressed on B cells and monocytes [57] and blockade of this communication between ICOS and B7RP-1 may have favourable outcome in the treatment of SLE. AMG 557 is a fully human mAb that binds to B7RP-1 [64].…”

Drugs in early clinical development for Systemic Lupus Erythematosus

“…The blockade of this co-stimulation mechanism has been effective in murine lupus models (58,59). Co-stimulatory pathways include CD28, CD40/CD40L, cytotoxic T lymphocyte antigen 4 (CTLA4), CD80 (B7-1), and CD86 (B7-2) (60). The CD28:B7 co-stimulatory interaction has been targeted therapeutically in SLE.…”