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  • Review Article
  • Published:

Pragmatic approaches to therapy for systemic lupus erythematosus

Key Points

  • Antimalarial agents and NSAIDs are the mainstay of current treatment for systemic lupus erythematosus (SLE)

  • Additional glucocorticoids and cytotoxic agents—such as azathioprine, mycophenolate mofetil, cyclophosphamide, cyclosporine and methotrexate —are used for SLE with specific organ manifestations

  • The BAFF-targeted antibody belimumab is the first biologic agent to be approved by the FDA for SLE, and can be used as an add-on treatment for patients with highly active disease

  • The anti-CD20 antibody rituximab, although not currently approved for SLE, might be an option for patients with refractory disease

Abstract

Systemic lupus erythematosus (SLE) is a complex autoimmune disease with substantial clinical heterogeneity. Current treatments for SLE are effective at reducing morbidity and mortality but fail to provide a cure, and they frequently have adverse effects. Traditional treatments include NSAIDs and antimalarial agents, which are the first-line therapies for mild SLE. In addition, glucocorticoids and cytotoxic or immunosuppressive agents—such as azathioprine, mycophenolate mofetil, cyclophosphamide, cyclosporine and methotrexate —are used for SLE with organ involvement. Advances in understanding the immunopathogenesis of SLE have led to the development of targeted immunotherapies, such as the anti-BAFF antibody belimumab, which has been approved as an add-on therapy for patients who have active disease despite receiving standard therapy. This Review presents an overview of the current therapies and nonpharmacological management approaches for SLE, and discusses the best approaches for treating specific disease manifestations such as lupus nephritis, neuropsychiatric lupus and cutaneous lupus erythematosus.

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Figure 1: Algorithm for the treatment of SLE.
Figure 2: Mechanisms of action of targeted therapies in SLE.

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Both authors contributed to discussing the content of the article, researching data and writing the manuscript. In addition, R. G. Lahita reviewed/edited the manuscript before submission.

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R. G. Lahita declares that he has received consultancy fees and honoraria for speaking from GlaxoSmithKline. W. Xiong declares no competing interests.

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Xiong, W., Lahita, R. Pragmatic approaches to therapy for systemic lupus erythematosus. Nat Rev Rheumatol 10, 97–107 (2014). https://doi.org/10.1038/nrrheum.2013.157

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