Systemic lupus erythematosus—2005 annus mirabilis?

Abstract

We are about to enter a new era in the treatment of patients with systemic lupus erythematosus (SLE). For the past 40 years hydroxychloroquine sulfate and corticosteroids, together with varying combinations of immunosuppressive drugs, have been the main treatments for SLE. Although effective for many patients, some patients fail to respond to these drugs and even more suffer from major side effects due to the generalized nature of the immunosuppression. In this article we review the remarkable confluence of new therapies ranging from newer immunosuppressive drugs with fewer side effects, such as mycophenolate mofetil, to the more targeted approaches offered by biological agents. These agents have been designed to block molecules such as CD20, CD22 and interleukin-10 that are thought to have an integral part in the development of SLE. This wolf might not yet be about to become extinct but its survival is increasingly under threat!

Key Points

  • The current treatments for of systemic lupus erythematosus (SLE) are unsatisfactory

  • Hydroxychloroquine sulfate still has a place in the management of SLE because of its low record of toxicity and its potential role in lowering cholesterol

  • Mycophenolate mofetil is equally effective and better tolerated than cyclophosphamide at inducing SLE remission and as good as azathioprine at maintaining remission

  • B-cell depletion using a combination of cyclophosphamide, steroids and rituximab looks promising for reducing clinical features of SLE, but these results need to be confirmed in double-blind controlled trials

  • Anticytokine therapies and antagonists of the B-lymphocyte stimulating protein have shown promise in early therapeutic studies

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Figure 1: Interactions between T cells and antigen-presenting cells.
Figure 2: Interactions between T cells and B cells.

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Correspondence to David Isenberg.

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Competing interests

Professor Isenberg has consulted for Amgen, Roche, Teva,Immunomedics, Aspreva and Celltech. He does not accept any personal fee; an equivalent sum is donated to an arthritis charity.

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Isenberg, D., Rahman, A. Systemic lupus erythematosus—2005 annus mirabilis?. Nat Rev Rheumatol 2, 145–152 (2006). https://doi.org/10.1038/ncprheum0116

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