Advances in the treatment of systemic lupus erythematosus: From back to the future, to the future and beyond - 01/06/19
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Highlights |
• | There have been many advances in the diagnosis and therapeutic management of systemic lupus erythematosus. |
• | The many progresses made by chemical industry have allowed the identification of valuable immunosuppressive therapeutic compounds which have profoundly changed the face of the disease. |
• | The favourable survival (> 90% at 10 years) in most dedicated centres does not hinder the fact that several gaps in the care of SLE patients remain. |
• | With the approval of belimumab and more than 74 targeted therapies in clinical development, we may expect great changes in the therapeutic management of SLE. |
• | Current challenges are shifting from whether some new drugs will be available to how to choose the most adequate drug (or combination) at the patient-level. |
Abstract |
There have been many advances in the diagnosis and therapeutic management of systemic lupus erythematosus (SLE) over the past decades. Following more than eleven centuries of therapeutic uncertainty, the discovery of the therapeutic properties of glucocorticoids is without any doubt one of the most significant advance in the field of autoimmune diseases. The many progresses made by rapidly growing chemical industry of the 19th century chemistry have allowed the identification of valuable therapeutic compounds such as anti-malarials, cyclophosphamide, azathioprine, cyclosporine and later mycophenolate mofetil, which have all profoundly changed the face of the disease. A very visible consequence of this is the profound improvement in the prognosis of the disease, with 10-year survival rates of more than 90% in most dedicated centres. Following the development of biotherapies in rheumatoid arthritis, the late 20th century has slowly opened a new era for the treatment of SLE, that of targeted therapies. With the approval of belimumab in 2011 and 74 targeted therapies in clinical development, we may expect great changes in the therapeutic management of SLE. Those molecules target inflammatory cytokines or chemokines and their receptors, B cells or plasma cells, intracellular signalling pathways, B/T cells co-stimulation molecules, interferons, plasmacytoid dendritic cells, as well as various other targets of interest. Current challenges are now slowly shifting from whether some new drugs will be available to how to select the most adequate drug (or drug combination) at the patient-level.
Le texte complet de cet article est disponible en PDF.Keywords : Systemic Lupus Erythematosus, Treatment, Targeted therapies, Immunosuppressant, Glucocorticoids
Plan
Vol 86 - N° 4
P. 429-436 - juillet 2019 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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