10 most important contemporary challenges in the management of SLE

Abstract

From a 1-year survival of less than 50% before the discovery of glucocorticoids to over 90% at 10 years in most dedicated centres, the spectrum of SLE has profoundly evolved. Despite this improvement, several major challenges currently remain. The aim of this review is to analyse what are, according to us, the 10 most important contemporary challenges in the management of SLE. Among those are the need to treat to target to favour disease remission (or low disease activity), limit the use of glucocorticoids, derive more comprehensive tools for the evaluation of disease activity, develop more effective drugs (yielding successful trials), dissect the heterogeneity of the disease both at the molecular and genetic levels, identify relevant biomarkers for individualised treatment, manage fertility and pregnancy, tackle comorbidities such as cardiovascular risk, the prevention of infections and osteoporosis, improve the network of care (from the patients’ perspective), and favour a holistic approach (integrating fatigue, adherence to treatment, physical activity). Altogether, these 10 contemporary challenges in SLE may be considered as a roadmap for those involved in the daily care of patients with SLE, as well as for researchers who may wish to contribute to an improved management of this rare and complex disease.

Adults with systemic lupus exhibit distinct molecular phenotypes in a cross-sectional study

“…Lack of understanding of the molecular heterogeneity of SLE remains a major deterrent to optimized individualized therapy, novel target identification, therapeutic development, and clinical trial success. Indeed, dissection of disease heterogeneity has been considered one of the ten most important contemporary challenges in SLE management [31] and is highlighted as a key obstacle for development of novel treatments [2]. Three decades of failed clinical trials and limited evidence to guide the selection of standard of care treatments hinder optimal care for individual SLE patients [1].…”

Systemic lupus erythematosus: what do Chinese patients and general practitioners know?

“…Despite the improvement of diagnosis and treatment, numerous challenges remain for the management of SLE. The challenges can include favouring disease remission, limiting the use of glucocorticoids, managing fertility and pregnancy, managing comorbidities and so on [2] . Besides, current evidence suggests that the percentage of nonadherent patients ranged from 37% to 75%, which have a remarkable correlation with depression, low education level and polypharmacy [3][4][5][6][7] .…”

Frequency and predictors of the Lupus Low Disease Activity State in Chinese patients with systemic lupus erythematosus: a prospective observational cohort study

“…Background Systemic lupus erythematosus (SLE) is a challenging chronic autoimmune disorder with variable clinical manifestations. The survival rate of patients with SLE has got progressive improvement with early diagnosis and pharmacopoeia development over the past decades; however, the mortality of SLE is still twice of the general population [1][2][3][4].…”