Abstract:
Introduction. Systemic lupus erythematosus (SLE) is an
autoimmune disease affecting multiple organs, leading to
significant morbidity and mortality. Despite treatment advancements, SLE activity, comorbidities, and drug toxicity
still cause irreversible damage and increased mortality. SLE
treatment now includes biologics, with belimumab being
the first approved. New therapies targeting interferons,
cytokines, intracellular signals, plasma cells, T lymphocytes, and co-stimulatory molecules are under evaluation.
Aim of the study. To investigate modern strategies in SLE
treatment. Material and methods. A systematic review of
the published in the past 5 years literature was conducted
which focused on modern strategies in the treatment of SLE.
Results. Approved biologics for SLE include belimumab and
anifrolumab. Belimumab reduces mortality in SLE patients
(0.4/100 person-years) compared to the general population (1.63/100 person-years), despite a slow response rate.
Non-corticosteroid immunosuppressants like cyclophosphamide, mycophenolate mofetil, and azathioprine are crucial for reducing SLE activity and are used for both initiating
and maintaining therapy. Resistance to glucocorticoids and
these immunosuppressants is common. Calcineurin inhibitors like cyclosporin A indirectly affect B cells by suppressing T cells and are safe for pregnant women. Biologics offer
an alternative for patients not responding to conventional
drugs, with sequential therapy enhancing B-cell depletion
effectiveness. Conclusion. Devising a standardized treatment approach for all SLE patients poses a challenge due
to the intricate pathogenesis and diverse clinical manifestations of the disease. Immunological profiling and precision
medicine, based on transcriptome analysis, can help identify immune phenotypes and gene signatures in SLE patients,
leading to better understanding and treatment outcomes.
