Recent Developments in Biologic Therapies for the Treatment of Patients With Systemic Lupus Erythematosus

Pedro L. Carreira; David A. Isenberg


Rheumatology. 2019;58(3):382-387. 

In This Article

Abstract and Introduction


SLE has a complex pathogenesis, and multiple therapeutic targets have been discovered in recent years. In spite of belimumab being approved by the US Food and Drug Administration and the widespread use of rituximab, there have been many failed attempts to treat SLE successfully using biologic agents. In this review, we consider newer biologic approaches that might offer the hope of improving the outcome of SLE patients. These include the fully humanized anti-CD20 mAbs, PEGylated anti-CD40L, IFNα inhibitors, rigerimod and immune complexes blockade.


The use of biologic therapies in the treatment of patients with SLE is, arguably, at least a decade behind their use in RA, PsA and AS. The need for more successful biologic or other new therapies remains important as it is clear we have reached the limit of what can be achieved with conventional immunosuppression.[1] SLE patients have ~90% survival rate at 10 years[2] with considerable morbidity, which remains very unsatisfactory for a disease that often develops before age 30.

Some encouragement is taken from the approval of belimumab by the US Food and Drug Administration (and more recently the National Institute for Health and Clinical Excellence) and the widespread use of rituximab (in spite of two trials that did not meet their endpoints). Neither drug alone will be a panacea for SLE, although interestingly attempts to combine those drugs are now being pursued. In this mini-review we will focus on several new or modified approaches that we believe offer the best hope of improving the outcome of SLE patients. Our choice of new approaches is subjective, based on our reading of the recent literature.