Modern strategies in the treatment of systemic lupus erythemtosus

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.