New developments in the treatment of systemic lupus erythematosus

Kjell Tullus

A large number of new studies on the treatment of systemic lupus erythematosus (SLE) have recently been or are about to be published. Unfortunately, all these studies have been performed in adult patients and there are no studies in children. There is, however, a strong need for more effective drugs with, if possible, fewer side-effects also in children. We do thus need to carefully asses the studies in adult patients to evaluate which of the new drugs can be tried in children with severe lupus nephritis. Some of the new studies have been largely confirmatory, such as demonstrating the efficacy of mycophenolate mofetil in the treatment of SLE, but others have been surprising, such as the lack of efficacy of rituximab. The debate as to why the rituximab studies got negative results is ongoing. Lastly, there is an emergence of novel medications for the treatment of SLE, mostly monoclonal antibodies targeting various aspects of the immune system: belimumab, an antibody affecting B-cell function, is likely to become the first new drug registered for lupus for many years as several large randomized studies have shown significant (albeit not dramatic) responses to this antibody. Many other drugs are in the pipeline and will hopefully come to the clinical arena. This review aims to give a critical appraisal of the plethora of studies in the context of the clinical reality of a pediatric nephrologist treating patients with SLE.