Novel Pharmacologic Therapies in the Treatment of Systemic Lupus Erythematosus

Seung Cheol Shim

doi:10.7599/hmr.2012.32.2.83

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Shim: Novel Pharmacologic Therapies in the Treatment of Systemic Lupus Erythematosus

Review Article

Hanyang Medical Reviews

Hanyang Medical Reviews 2012; 32(2): 83-93.

Published online: 25 May 2012

DOI: https://doi.org/10.7599/hmr.2012.32.2.83

Novel Pharmacologic Therapies in the Treatment of Systemic Lupus Erythematosus

Seung Cheol Shim, M.D., Ph.D.

Division of Rheumatology, Department of Internal Medicine, Eulji Medi-Bio Research Institute, Eulji University School of Medicine, Daejeon, Korea.

Corresponding author (ssc@eulji.ac.kr)

Received 25 February 2012 Accepted 4 May 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Systemic lupus erythematosus (lupus) is an autoimmune disease that affects primarily women, especially those of reproductive age. Lupus is a prototypic organ non-specific autoimmune disease that may affect any organ in the body resulting in displaying a broad spectrum of clinical and immunological manifestations. The pathogenesis of lupus involves a complex interplay between genetic and environmental factors and the adaptive and innate immune systems. Defects in central and peripheral tolerance, increased antigenic load, excess T-cell help, B cell hyperactivity, autoantibody production and cytokine imbalance, ultimately lead to immune-complex formation and complement activation causing immunologically mediated organ damage, culminating in premature death. There is an urgent need for the development of novel agents since many patients are refractory to traditional agents. However, there are two hurdles that make development of new therapeutic agents difficult. First, we do not understand the whole picture of the pathogenesis of lupus because of its complex and multi-systemic presentation. Secondly, lupus lacks a reliable and sensitive biomarker for measuring disease activity, and a standardized method for defining response to therapy. Nevertheless, great advances have been made during the past 10 years because of the great efforts of basic researchers and clinicians on elucidating the cause of the disease, and participation of pharmaceutical and biotechnical companies in the development of novel agents. My goal was to evaluate the efficacy and safety of novel pharmaceutical agents by a comprehensive review of open-label and randomized clinical trials conducted in patients with lupus.

Keywords: Lupus Erythematosus, Systemic, Pharmaceutical Services, Biological Agents

Figures and Tables

Fig. 1

Function of B cell.

Ab, antibody; LN, lymph node; APC, antigen presenting cells

Table 1

Cell Surface Antigens Expressed on B Cells

Table 2

Novel Therapies being Developed for SLE Treatment

INN, nternational Nonproprietary Name; BlyS, B lymphocyte stimulator; IL-1, interleukin 1; TNFα:,tumor necrosis factor α; IFNα : interferon α

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