Systemic lupus erythematosus: modern strategies for management – a moving target

In the past decade, advances in the area of lupus have led to a significant expansion in our armamentarium of therapeutics, although none is yet approved by the FDA for use in SLE. The use of mycophenolate mofetil has been a substantial advance. Recent clinical trials have shed light on optimizing usages and alternatives of more traditional therapies, such as antimalarials, cyclophosphamide, azathioprine, and mycophenolate mofetil. In addition, targeting components of the immune system has yielded promising new therapies in the arena of biologics, anticytokine therapy, and stem-cell transplantation, which are currently being tested. As data from ongoing trials evolve, our questions involving appropriate patient selection and disease indications will help bridge the gaps in our knowledge and understanding of administration of such potential therapies. Future innovative strategies might include further exploration of: (1) the body's inherent tolerance mechanisms, such as promoting T regulatory cells that help suppress self reactive immune cells; (2) targeting interferon pathways known to be dysregulated in patients with SLE; and (3) exploring interactions between the innate and adaptive immune system, such as studying toll-like receptors and dendritic cell activation.

• A greater understanding of immunopathogenesis has led to the development of biologics targeting individual components of the immune repertoire.

• Future studies are warranted for further investigation of the utility of biologics and promise of stem-cell transplantation in patients with SLE.

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