REVIEW - Update on immunotherapy for SLE - what's hot and what's not!

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Rheumatology Advance Access published online on January 20, 2009

Rheumatology, doi:10.1093/rheumatology/ken476

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Review

Update on immunotherapy for systemic lupus erythematosus—what's hot

and what's not!

M. Y. Karim1, C. N. Pisoni1 and M. A. Khamashta1

1Lupus Research Unit, The Rayne Institute, Guy's and St '

Hospitals NHS Foundation Trust, London, UK.

Abstract

There have been significant advances in the treatment of SLE, which

have produced major impacts on morbidity and in some cases mortality.

The major drugs of the last three decades in treatment of SLE have

been corticosteroids, AZA, MTX and cyclophosphamide. However, these

drugs have considerable toxicities, and with the increasing knowledge

of the immune system, and further understanding of SLE

immunopathogenesis, many groups are seeking to identify and trial

novel immunotherapeutic strategies. These have included therapies

aimed at influencing particular immune cells (e.g. B cells) and

molecules (e.g. costimulatory molecules, cytokines) which are thought

to be important in disease pathogenesis. The advantage of such

therapies is that efficacy may be achieved with lower toxicity, and

without wide-ranging suppression of the immune system. Success has not

always been achieved by specific design of immunotherapies for SLE,

and the best recent example has been the use of B-cell depletion

therapy, a concept derived from its successful use in RA. In this

article, we discuss those immunotherapeutic strategies that have

arrived as far as clinical trials in human subjects. In addition to

these relatively specific immunotherapies, we also highlight the use

of mycophenolate mofetil, an anti-proliferative immunosuppressant

which has had good success over the last 10 yrs, with similar early

efficacy to cyclophosphamide when used as induction therapy for lupus

nephritis. Data are presented on more generalized immune strategies,

such as the use of stem cell transplantation and intravenous

immunoglobulin.

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Read the full article here:

http://rheumatology.oxfordjournals.org/cgi/content/full/ken476v1

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