Tailored treatment strategies and future directions in systemic lupus erythematosus

Nikolopoulos, Dionysis; Fotis, Lampros; Gioti, Ourania; Fanouriakis, Antonis

doi:10.1007/s00296-022-05133-0

Cited by 8 publications

(7 citation statements)

References 110 publications

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“…When applied in clinic, depletion of B cells by mAbs has limited therapeutic efficacy as they can’t access autoreactive B cells within lymphatic organs and inflamed tissues ( 81 , 82 ). Then, mAbs can hardly deplete B cell completely.…”

Section: Discussionmentioning

confidence: 99%

“…Take from this, CART.BiTE targeting B cells' antigen provides a new solution for autoimmune diseases in the future. When applied in clinic, depletion of B cells by mAbs has limited therapeutic efficacy as they can't access autoreactive B cells within lymphatic organs and inflamed tissues (81,82). Then, mAbs can hardly deplete B cell completely.…”

Section: The Advantages and Disadvantages Of Both Approachesmentioning

confidence: 99%

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B cell depletion therapies in autoimmune diseases: Monoclonal antibodies or chimeric antigen receptor-based therapy?

Zhang

Huang

2023

Front. Immunol.

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Immune system detects foreign pathogens, distinguishes them from self-antigens and responds to defend human body. When this self-tolerance is disrupted, the overactive immune system attacks healthy tissues or organs and the autoimmune diseases develop. B cells and plasma cells contribute a lot to pathogenesis and persistence of autoimmune diseases in both autoantibody-dependent and autoantibody-independent ways. Accumulating data indicates that treatments aiming to eliminate antibody-secreting cells (B cells or plasma cells) are effective in a wide spectrum of autoimmune diseases. Monoclonal antibodies (mAbs) deplete B cell lineage or plasma cells by signaling disruption, complement-dependent cytotoxicity (CDC) and antibody-dependent cellular cytotoxicity (ADCC). Engineered-T cells armed with chimeric antigen receptors (CARs) have been adopted from field of hematological malignancies as a method to eliminate B cells or plasma cells. In this review, we update our understanding of B cell depletion therapies in autoimmune diseases, review the mechanism, efficacy, safety and application of monoclonal antibodies and CAR-based immunotherapies, and discuss the strengths and weaknesses of these treatment options for patients.

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Section: Discussionmentioning

confidence: 99%

Section: The Advantages and Disadvantages Of Both Approachesmentioning

confidence: 99%

B cell depletion therapies in autoimmune diseases: Monoclonal antibodies or chimeric antigen receptor-based therapy?

Zhang

Huang

2023

Front. Immunol.

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“…Therefore, in-depth research on the pathogenesis of lupus nephritis will bring hope for future precise treatment that directly targets specific cells, autoantibodies, cytokines and chemokines to regulate inflammation and tissue damage ( 118 ). As an autoimmune disease involving multiple organs and systems, the abnormal activation of T and B lymphocytes in SLE patients causes inflammatory injury ( 119 ), and iguratimod has the effect of regulating T, B lymphocytes and antigen presenting cells, so iguratimod has potential for SLE treatment.…”

Section: Iguratimod In the Treatment Of Rheumatic Bone Diseases And A...mentioning

confidence: 99%

Research progress on the clinical application and mechanism of iguratimod in the treatment of autoimmune diseases and rheumatic diseases

Long,

Zeng,

et al. 2023

Front. Immunol.

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Autoimmune diseases are affected by complex pathophysiology involving multiple cell types, cytokines, antibodies and mimicking factors. Different drugs are used to improve these autoimmune responses, including nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, antibodies, and small molecule drugs (DMARDs), which are prevalent clinically in the treatment of rheumatoid arthritis (RA), etc. However, low cost-effectiveness, reduced efficacy, adverse effects, and patient non-response are unattractive factors driving the development of new drugs such as iguratimod. As a new disease-modifying antirheumatic drug, iguratimod has pharmacological activities such as regulating autoimmune disorders, inflammatory cytokines, regulating immune cell activation, differentiation and proliferation, improving bone metabolism, and inhibiting fibrosis. In recent years, clinical studies have found that iguratimod is effective in the treatment of RA, SLE, IGG4-RD, Sjogren ‘s syndrome, ankylosing spondylitis, interstitial lung disease, and other autoimmune diseases and rheumatic diseases. The amount of basic and clinical research on other autoimmune diseases is also increasing. Therefore, this review systematically reviews the latest relevant literature in recent years, reviews the research results in recent years, and summarizes the research progress of iguratimod in the treatment of related diseases. This review highlights the role of iguratimod in the protection of autoimmune and rheumatic bone and related immune diseases. It is believed that iguratimod’s unique mode of action and its favorable patient response compared to other DMARDs make it a suitable antirheumatic and bone protective agent in the future.

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“…4 Although several SLE treatment strategies are available, none are entirely effective and vary from person to person. 5 One primary concern is the need for high doses of medications, which may result in treatment side effects, 6 prompting researchers to investigate alternative treatment strategies for SLE patients.…”

Section: Introductionmentioning

confidence: 99%

“…Belimumab is administered in addition to the standard treatment to SLE patients with persistent disease activity and organ‐threatening or refractory disease; rituximab may be a treatment option 4 . Although several SLE treatment strategies are available, none are entirely effective and vary from person to person 5 . One primary concern is the need for high doses of medications, which may result in treatment side effects, 6 prompting researchers to investigate alternative treatment strategies for SLE patients.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of baricitinib for the treatment of systemic lupus erythematosus patients: A meta‐analysis of randomized controlled trials

Panda,

Ranjan,

Sahu

2023

Int J of Rheum Dis

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BackgroundSystemic lupus erythematosus (SLE) is an autoimmune disorder characterized by abnormal autoantibody production, inflammation, and organ damage. Most SLE treatment strategies aim to induce remission or reduce disease activity while avoiding flares. Baricitinib has been used effectively to manage various inflammatory diseases, and some randomized controlled trials (RCT) have shown that it is beneficial in treating SLE. The current study aims to assess the efficacy of baricitinib in treating SLE patients.Materials and MethodsVarious databases such as PubMed, Scopus, and Science Direct were searched to obtain eligible studies for the present meta‐analysis. Data such as baseline characteristics of patients, doses of the baricitinib, follow‐up duration, and treatment outcome in the form of SLE responder index‐4 (SRI‐4) and lupus low disease activity state (LLDAS) were extracted. Combined odds ratio, 95% confidence interval, and probability values were calculated to study the efficacy of baricitinib in treating SLE patients. A p‐value less than .05 was taken as significant. Comprehensive meta‐analysis v3 was used for all analyses.ResultsThree articles were found eligible for the present meta‐analysis comprising 614 patients with placebo, 614 SLE patients receiving 4 mg, and 621 patients with 2 mg of baricitinib. Meta‐analysis revealed a beneficial effect of 4 mg baricitinib in SLE patients compared to placebo, as measured by an increase in the SRI‐4 (p = .006, OR = 1.370) and LLDAS (p = .083, OR = 1.252) rates. In contrast to the placebo group, however, patients receiving 2 mg of baricitinib exhibited no significant improvement. The trial sequential analysis revealed the need for additional RCTs to determine the role of baricitinib in treating SLE patients.ConclusionIn treating SLE patients, administrating a higher dose of baricitinib (4 mg) may be effective. However, additional RCTs in different populations with larger sample sizes are required to validate our findings.

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Tailored treatment strategies and future directions in systemic lupus erythematosus

Cited by 8 publications

References 110 publications

B cell depletion therapies in autoimmune diseases: Monoclonal antibodies or chimeric antigen receptor-based therapy?

B cell depletion therapies in autoimmune diseases: Monoclonal antibodies or chimeric antigen receptor-based therapy?

Research progress on the clinical application and mechanism of iguratimod in the treatment of autoimmune diseases and rheumatic diseases

Efficacy of baricitinib for the treatment of systemic lupus erythematosus patients: A meta‐analysis of randomized controlled trials

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