Perspectives of Systemic Lupus Erythematosus Therapy

Although systemic lupus erythematosus (SLE) is a complex autoimmune disease of unknown origin, recent advances in our understanding of its pathogenesis have suggested new, targeted approaches to therapy. In this review the underlying scientific rationale and results of clinical studies of new treatment approaches to SLE are discussed with a focus on cell-depleting therapies and cytokine blockade. It has become clear that B lymphocytes play a key role in the disease's pathogenesis and aberrant interaction between B and T cells are critical to its emergence progression. New agents that directly target immune cells which are abnormal in SLE include B-cell-depleting (anti-CD20) and -modulating (anti-CD22) antibodies. Another promising approach is to block co-stimulatory interactions between T and B cell (CTLA-41g). Immune cells can also be manipulated indirectly through cytokine effects (anti-BAFF). Pro-inflammatory cytokines can be blocked in SLE (anti-TNF anti-IL-10). Most of the available data on these new treatment approaches item from open-label trials, but controlled trials are under-way (Adv Clin Exp Med 2008, 17, 4, 433-439).