Current Treatment Approach, Emerging Therapies and New Horizons in Systemic Lupus Erythematosus

Abstract

Systemic lupus erythematosus (SLE), the prototype of systemic autoimmune diseases is characterized by extreme heterogeneity with a variable clinical course. Renal involvement may be observed and affects the outcome. Hydroxychloroquine should be administered to every lupus patient irrespective of organ involvement. Conventional immunosuppressive therapy includes corticosteroids, methotrexate, cyclophosphamide, mycophenolate mofetil, azathioprine, cyclosporine and tacrolimus. However, despite conventional immunosuppressive treatment, flares occur and broad immunosuppression is accompanied by multiple side effects. Flare occurrence, target organ involvement, side effects of broad immunosuppression and increased knowledge of the pathogenetic mechanisms involved in SLE pathogenesis as well as the availability of biologic agents has led to the application of biologic agents in SLE management. Biologic agents targeting various pathogenetic paths have been applied. B cell targeting agents have been used successfully. Belimumab, a B cell targeting agent, has been approved for the treatment of SLE. Rituximab, an anti-CD20 targeting agent is also used in SLE. Anifrolumab, an interferon I receptor-targeting agent has beneficial effects on SLE. In conclusion, biologic treatment is applied in SLE and should be further evaluated with the aim of a good treatment response and a significant improvement in quality of life.

Cumulative pulse methylprednisolone and its relation to disease activity, damage and mortality in systemic lupus erythematosus patients: A post hoc analysis of COMOSLE-EGYPT study

“…In this study, higher cumulative pulse methylprednisolone was associated with higher damage in lupus patients and that damage was expanded (increased) by 0.169 for every gram increase in the cumulative pulse level, which is in agreement with several studies that documented glucocorticoid-induced damage in lupus patients [ 14 – 18 ], describing up to 80% of organ damage in SLE being attributable to glucocorticoid use [ 19 ], with a clear dose-dependent relationship [ 4 ]. This also goes in line with the recommendation of limiting glucocorticoid use to the shortest possible time and the lowest dose possible [ 20 ]. The study by Badsha et al (2003) confirmed that 1–1.5 g methylprednisolone versus 3–5 g methylprednisolone total dosage over 3 days may show equal efficacy, but with higher complications and risk of infection observed with the higher (3–5 g) dose [ 7 ].…”

Serum Advanced Glycation End Products and Their Soluble Receptor as New Biomarkers in Systemic Lupus Erythematosus

“…In the case of the positive association with photosensitivity, we have several hypotheses: Firstly, patients who are photosensitive tend to protect themselves more from ultraviolet radiation, a notorious trigger for both cutaneous and systemic flares in SLE [ 51 ]. Secondly, photosensitive patients are normally treated with drugs that are photoprotective like hydroxychloroquine, which is known to absorb ultraviolet light in the skin in a concentration-dependent manner; it has also been demonstrated to reduce mortality in SLE [ 52 ] by preventing flares and organ damage, and by having an effect in other comorbidities such as thrombosis or bone destruction [ 53 ].…”

An Overview of Methotrexate Indications in Skin Diseases

“…Two single-center retrospective studies reported the effectiveness of MTX in the treatment of discoid cutaneous and refractory systemic lupus. Lehman et al suggested that the use of MTX in pediatric SLE should be reserved for patients with severe nephritis who are resistant to cyclophosphamide [46][47][48].…”