Treating systemic lupus erythematosus in the 21st century: new drugs and new perspectives on old drugs

Abstract

Besides treating acute flares, the management of SLE should aim at preventing organ damage accrual and drug-associated harms, improving health-related quality of life and prolonging survival. At present, therapy is based on combinations of antimalarials (mainly HCQ), considered the backbone of SLE treatment, glucocorticoids and immunosuppressive drugs. However, these regimens are not universally effective and a substantial degree of damage can be caused by exposure to glucocorticoids. In this review we provide a critical appraisal of the efficacy and safety of available treatments as well as a brief discussion of potentially novel compounds in patients with SLE. We emphasize the use of methylprednisolone pulses for moderate–severe flares, followed by low–moderate doses of oral prednisone with quick tapering to maintenance doses of ≤5 mg/day, as well as the prompt institution of immunosuppressive drugs in the setting of severe disease but also as steroid-sparing agents. Indications for the use of biologic agents, namely belimumab and rituximab, in refractory or organ-threatening disease are also presented. We conclude by proposing evidence- and experience-based treatment strategies tailored to the clinical scenario and prevailing organ involvement that can aid clinicians in managing this complex disease.

Novel Therapeutic Strategy Based on Neutrophil Subset and Its Function in Autoimmune Disease

“…The most common autoimmune diseases require glucocorticoid (GC) therapy to induce disease remission at onset/or flare and prevent relapse for a long time. However, GCs are a main cause of toxicity, including diabetes, infections, fractures, and atherosclerosis ( Ruiz-Irastorza and Bertsias, 2020 ), leading to impaired quality of life and decreased survival in patients with autoimmune disease. In particular, cardiac involvement and chronic kidney disease underlying atherosclerosis are frequently seen in patients with SLE and AAV due to their own disease and off-target effects of GCs ( Kronbichler et al, 2020 ).…”

Massive haemorrhage: an unusual presentation of systemic lupus erythematosus

“…Modifying cytokine response, manipulation of toll-like receptors, chemokines and specific B cell therapies can serve as potential emerging treatment. 9 …”

Systemic Lupus Erythematosus Disease: An Overview of the Clinical Approach to Pathogenesis, Diagnosis, and Treatment

“…There is no cure for SLE at present, but the condition is most often very treatable and usually responds well to some different types of drugs-especially when treatment is started in the early stages of the disease 38 . Most of the drugs described in Table III were initially developed for other diseases but were later found to be helpful in SLE 39 .…”