Management strategies and future directions for systemic lupus erythematosus in adults

Durcan, Laura; O’Dwyer, Tom; Petri, Michelle

doi:10.1016/s0140-6736(19)30237-5

Cited by 422 publications

(290 citation statements)

References 148 publications

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“…Apart from those conventional drugs such as immunosuppressants and corticosteroids, the advances in targeted biological agents have substantially improved the prognosis of SLE patients [155]. However, adequate control of disease activity or achieving remission is still challenging for a large part of SLE patients, and those patients are at high risk of premature mortality [4]. Therefore, more innovative treatment strategies need to be developed to improve the prognosis of SLE patients.…”

Section: Journal Of Immunology Researchmentioning

confidence: 99%

“…Apart from the physical impairment, rheumatic diseases also have caused a heavy socioeconomic burden [2,3]. The treatment of rheumatic diseases such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and Sjögren's syndrome (SjS) varies across patients with different clinical characteristics [4][5][6]. Current therapies for rheumatic diseases mainly include conventional synthetic disease-modifying antirheumatic drugs (DMARDs) and newly developed biologic therapies [4,7].…”

Section: Introductionmentioning

confidence: 99%

“…The treatment of rheumatic diseases such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and Sjögren's syndrome (SjS) varies across patients with different clinical characteristics [4][5][6]. Current therapies for rheumatic diseases mainly include conventional synthetic disease-modifying antirheumatic drugs (DMARDs) and newly developed biologic therapies [4,7]. The introduction of biologic therapies has revolutionized the treatment of many rheumatic diseases such as RA and ankylosing spondylitis (AS) in the past decade.…”

Section: Introductionmentioning

confidence: 99%

“…The introduction of biologic therapies has revolutionized the treatment of many rheumatic diseases such as RA and ankylosing spondylitis (AS) in the past decade. However, a large part of patients with rheumatic diseases are still not well treated, which is possibly attributed to poor response to ther-apeutic agents, delayed diagnosis, or poor medication adherence [4,7,8]. Additionally, biologic therapies such as tumor necrosis factor-α (TNF-α) antagonists (monoclonal antibodies or soluble receptors) can increase the risk of opportunistic infections such as tuberculosis [9].…”

Section: Introductionmentioning

confidence: 99%

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Peptide-Based Vaccination Therapy for Rheumatic Diseases

Wang

Chen

Zheng

et al. 2020

Journal of Immunology Research

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Rheumatic diseases are extremely heterogeneous diseases with substantial risks of morbidity and mortality, and there is a pressing need in developing more safe and cost-effective treatment strategies. Peptide-based vaccination is a highly desirable strategy in treating noninfection diseases, such as cancer and autoimmune diseases, and has gained increasing attentions. This review is aimed at providing a brief overview of the recent advances in peptide-based vaccination therapy for rheumatic diseases. Tremendous efforts have been made to develop effective peptide-based vaccinations against rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), while studies in other rheumatic diseases are still limited. Peptide-based active vaccination against pathogenic cytokines such as TNF-α and interferon-α (IFN-α) is shown to be promising in treating RA or SLE. Moreover, peptide-based tolerogenic vaccinations also have encouraging results in treating RA or SLE. However, most studies available now have been mainly based on animal models, while evidence from clinical studies is still lacking. The translation of these advances from experimental studies into clinical therapy remains impeded by some obstacles such as species difference in immunity, disease heterogeneity, and lack of safe delivery carriers or adjuvants. Nevertheless, advances in high-throughput technology, bioinformatics, and nanotechnology may help overcome these impediments and facilitate the successful development of peptide-based vaccination therapy for rheumatic diseases.

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Section: Journal Of Immunology Researchmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Peptide-Based Vaccination Therapy for Rheumatic Diseases

Wang

Chen

Zheng

et al. 2020

Journal of Immunology Research

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“…In contrast with remission, low disease activity state was more appropriate as an early treatment target with higher attainability and sustainability [12][13][14][15][16][17][18][19]. Among the definitions of low disease activity in SLE, the Lupus Low Disease Activity State (LLDAS) developed by Asia-Pacific Lupus Collaboration was well-validated and widely accepted [9][10][11][20][21][22]. Previous studies had proved that the maintenance of LLDAS during follow-up was associated with a lower frequency of organ damage accrual or flare [14][15][16][22][23][24][25].…”

Section: Introductionmentioning

confidence: 99%

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

Gao

Hao

et al. 2019

Preprint

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Mycophenolate Mofetil and New-Onset Systemic Lupus Erythematosus

You,

Zhou,

Wang

et al. 2024

JAMA Netw Open

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ImportanceAnti–double-stranded DNA (dsDNA) antibody has been reported to have a close relationship with systemic lupus erythematosus (SLE) flares and participates in the pathogenesis of lupus nephritis (LN) as well as causing damage to other organs. However, whether early use of mycophenolate mofetil (MMF) could prevent SLE flares is not clear.ObjectiveTo assess the efficacy and safety of MMF plus prednisone and hydroxychloroquine sulfate compared with prednisone and hydroxychloroquine sulfate alone in patients with SLE.Design, Setting, and ParticipantsThis investigator-initiated, multicenter, observer-blinded randomized clinical trial enrolled 130 participants aged 18 to 65 years and was conducted in 3 hospitals across China. Treatment-naive patients with newly diagnosed SLE, a high titer of anti-dsDNA antibody, and no major organ involvement were included. The study was started September 1, 2018, and the follow-up was completed September 30, 2021. Data were analyzed from December 1, 2021, to March 31, 2022.InterventionsPatients were randomized 1:1 to receive oral prednisone (0.5 mg/kg/d) and hydroxychloroquine sulfate (5 mg/kg/d) (control group) or prednisone (0.5 mg/kg/d) and hydroxychloroquine sulfate (5 mg/kg/d) plus MMF (500 mg twice daily) (MMF group) for 96 weeks.Main Outcomes and MeasuresThe primary outcome was the proportion of patients presenting with flares according to the Safety of Estrogens in Lupus Erythematosus National Assessment–Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) Flare Index. The secondary outcomes included the proportion with lupus low disease activity state at week 96, 36-Item Short Form Health Survey scores before and after treatment, proportion of adverse events (AEs), and changes in SLEDAI-2000 scores and prednisone doses.ResultsAmong 130 randomized patients (mean [SD] age, 34.5 [12.5] years; 112 [86.2%] women), 119 (91.5%) completed the follow-up. The risk of severe flare was significantly lower in the MMF group (7 of 65 [10.8%]) vs the control group (18 of 65 [27.7%]) (relative risk [RR], 0.39 [95% CI, 0.17-0.87]; P = .01). Additionally, 1 of 65 patients in the MMF group (1.5%) and 9 of 65 in the control group (13.8%) manifested LN (RR, 0.11 [95% CI, 0.01-0.85]; P = .008). Most common serious study drug–related AEs were infections (20 of 65 [30.8%] in the control group and 22 of 65 [33.8%] in the MMF group).Conclusions and RelevanceThe findings of this randomized clinical trial suggest that MMF may reduce the rate of severe flare and lower the incidence of LN in patients with new-onset SLE and a high titer of anti-dsDNA antibody without major organ involvement.Trial RegistrationChinese Clinical Trial Registry: ChiCTR1800017540

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Management strategies and future directions for systemic lupus erythematosus in adults

Cited by 422 publications

References 148 publications

Peptide-Based Vaccination Therapy for Rheumatic Diseases

Peptide-Based Vaccination Therapy for Rheumatic Diseases

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

Mycophenolate Mofetil and New-Onset Systemic Lupus Erythematosus

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