We searched PubMed for articles published in English between Jan 1, 2005, and Feb 27, 2013, and Summon Search between Jan 1, 2005, and Feb 27, 2013, with the search terms “systemic lupus erythematosus” and “lupus” in combination with the terms “management” and “biologics”. We also searched the references of articles identified by this strategy and selected those that were relevant.
SeriesSystemic lupus erythematosus and other autoimmune rheumatic diseases: challenges to treatment
Introduction
The prognosis of patients with autoimmune rheumatic diseases has improved substantially. In the 1950s, the 4 year survival for patients with systemic lupus erythematosus was 50%, now 15 year survival is 85%.1 In this part of the Series on autoimmune rheumatic diseases, we briefly review the treatment of these disorders, focusing mainly on systemic lupus erythematosus, and highlight the recent advances that have been made in biological treatments.
Section snippets
Pharmacological management
The mechanisms of action and indications for the drugs used to treat autoimmune rheumatic diseases are diverse. The table summarises the commonly prescribed conventional drugs available for the treatment of systemic lupus erythematosus. The main advances in the past decade in the conventional management of systemic lupus erythematosus have included studies showing efficacy for mycophenolate as an induction agent for lupus nephritis7, 10 and the equivalent efficacy of low-dose cyclophosphamide
New biological treatments
Improved understanding of the immune response and abnormalities in apoptosis have allowed the recognition of cells and molecules that are crucial to the development of systemic lupus erythematosus and other autoimmune rheumatic diseases. Increased recognition of the multifaceted role that B cells have in the pathophysiology of systemic lupus erythematosus has led to the development of several novel treatments, notably rituximab and belimumab. The failure of some other agents targeted at
Controversies about the use of biological agents for autoimmune rheumatic diseases
By contrast with the highly successful introduction of biological drugs for the treatment of rheumatoid arthritis, the use of these drugs in systemic lupus erythematosus, Sjögren's syndrome, myositis, and vasculitis has remained more problematic. Some notable successes of clinical trials have been belimumab in systemic lupus erythematosus and rituximab in antineutrophil cytoplasmic antibody-positive vasculitis; however, several frustrating failures have also been reported including the use of
Conclusions
We are at a challenging crossroads with regards to the treatment of autoimmune rheumatic diseases. The limit of what conventional drugs can achieve has probably been reached. Improved understanding of the aetiopathogenesis of these diseases with the introduction of more targeted biological treatment is beginning to show some encouraging signs of improvement in the outlook for these patients. However, this improvement is still lagging behind what has been achieved in the past decade for
Search strategy and selection criteria
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