Recent advances in the management of systemic lupus erythematosus

Abstract

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease presenting highly heterogeneous clinical manifestations and multi-systemic involvement. Patients are susceptible to relapse­ and remission, thus making management challenging. Moreover, a considerable number of side effects may occur with conventional therapies; therefore, there is clearly a need for new therapeutic strategies. Since the pathogenesis of SLE is highly complex, it is far from being fully understood. However, greater understanding of the pathways and of the cellular and molecular mediators involved in SLE is being achieved. Emerging evidence has allowed the development of new biological therapeutic options targeting crucial molecular mediators involved in the pathogenesis of SLE. This literature review analyzes the availability of biological and target-directed treatments, phase II and III trials, and new therapies that are being developed for the treatment of SLE.

Correlations of Expression Levels of a Panel of Genes (IRF5, STAT4, TNFSF4, MECP2, and TLR7) and Cytokine Levels (IL-2, IL-6, IL-10, IL-12, IFN-γ, and TNF-α) with Systemic Lupus Erythematosus Outcomes in Jordanian Patients

“…Nevertheless, the contribution of SLE genes is considered one of the most important factors in disease susceptibility by virtue of their involvement in the production of autoantibodies and immune complexes, thus initiating the disease process [31]. Furthermore, it has been suggested that understanding the genetic origin of SLE is pivotal to develop new biological therapeutic approaches directed against molecular mediators of the disease since the conventional treatments are associated with side effects [41]. SLE patients, in the present study, demonstrated a significant increase in the expression of SLE susceptibility genes IRF5 , TLR7 , MECP2 , STAT4 , and TNFSF4 when compared to healthy volunteers, with MECP2 ( α ) expression having the highest value followed by IRF5 and MECP2 ( β ).…”

“…Detecting the levels of IFN-inducible genes such as IRF5 and STAT4 and cytokines such as TNF- α and IL-10 may be important toward the implementation of a more personalized therapeutic protocol that is safer than the conventional treatments. For example, it has been indicated that the use of short-term induction therapy with anti-TNF- α in SLE patients with severe joint involvement was a safe therapeutic approach [41], and biological treatments targeting type I IFN are currently in trial [27].…”

Clinical Efficacy of Routinely Administered Belimumab on Proteinuria and Neuropsychiatric Lupus

“…Systemic lupus erythematosus (SLE) is a rare autoimmune disease that can potentially affect every organ system (1). Many organ manifestations can be managed effectively with the available immunosuppressive therapies.…”

The Potential Use of Metformin, Dipyridamole, N-Acetylcysteine and Statins as Adjunctive Therapy for Systemic Lupus Erythematosus

“…Moreover, novel biologic agents, which are designed to be more selective in their immunosuppression mechanism, are not spared from major side effects, including hypogammaglobulinemia and progressive multifocal leukoencephalopathy related to rituximab [4,5]. Furthermore, clinical trials on the use of these biologic agents in SLE have yielded mixed results [6], with non-inferiority trials such as the EXPLORER and LUNAR trials on rituximab failing to reach their respective primary endpoints [7,8]. On the other hand, the BLISS-52 and BLISS-76 trials on belimumab (the first and only FDA-approved biologic agent for SLE treatment) have shown potentially promising results by reaching a more sophisticated primary endpoint [9,10].…”