Systemic lupus erythematosus: pharmacological developments and recommendations for a therapeutic strategy.
The management of systemic lupus erythematosus (SLE) has improved thanks to a better understanding of the immunopathogenesis of the disease and important advances in drug development. In contrast to the worrying paucity of new therapies for SLE at the end of the last century, several agents have emerged as useful treatments for this condition in the last decade. The efficacy of mycophenolate mofetil in the treatment of patients with lupus nephritis has been recently established in several clinical trials. There are increasing data from open-label studies to support the belief that B-cell depletion using the chimeric antibody rituximab is useful in the treatment of SLE. However, larger double-blind clinical trials to confirm this belief are awaited. Other specific targeted therapeutic agents that act by inducing B-cell depletion, inhibiting co-stimulatory molecules necessary for T-cell activation, tolerising B and T cells, blocking pro-inflammatory cytokines or complement and immunoablation are exciting advances in the race towards improving the outcome for patients with SLE.
Pego-Reigosa
Jose Maria
JM
Hospital do Meixoeiro (Complexo Hospitalario Universitario de Vigo), Rheumatology Section, Alto do Meixoeiro s/n, 36200 Vigo (Pontevedra), Spain. jose.maria.pego.reigosa@sergas.es
Isenberg
David A
DA
D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use*; D001402:B-Lymphocytes / Q000187:drug effects; D016207:Cytokines / Q000037:antagonists & inhibitors; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy* / Q000276:immunology / Q000628:therapy; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D009841:Oligonucleotides / Q000008:administration & dosage / Q000627:therapeutic use*; D013601:T-Lymphocytes / Q000187:drug effects
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D016207:Cytokines; D009841:Oligonucleotides; D009173:Mycophenolic Acid