Novel approaches to therapy for systemic lupus erythematosus

Gisele Zandman-Goddard, Yehuda Shoenfeld*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

Current therapies for systemic lupus erythematosus (SLE) are targeted at immunosuppression and at reducing inflammation. The current therapies are broad-spectrum and include steroids and cytotoxic agents that are counterbalanced by toxicity and side effects of the medications. Methotrexate can be utilized to reduce steroid requirements in mild to moderate SLE. Manipulation of the hormonal axis includes DHEA and bromocriptine. Mycophenolate mofetil is an immunosuppressive agent that is being investigated for SLE renal disease. Autologous stem cell transplantation or high-dose cyclophosphamide may be an option for severe refractory SLE. The aim of the future is to target therapies by altering specific known mechanisms of inflammation and autoimmunity. Although the inciting antigen is still unknown in SLE, it may be possible to alter the regulation of the immune response by targeted molecular therapy. Methods to do so would include manipulation of idiotypes, manipulation of second signal stimulation of the immune response, manipulation of cytokines, and the induction of tolerance by administration of blocking peptides. IVIg is an immunomodulator that has been successful in the treatment of SLE. Targeted molecular therapy is undergoing phase I trials with monoclonal anti-CD40L, a signaling inhibitor. Anti- CTLA4Ig, another signaling blocker, is presently being investigated for psoriasis, but may be a potential therapy for SLE. Finally, therapies may include the administration of peptides to induce tolerance. (C) 2000 Elsevier Science B.V.

Original languageEnglish
Pages (from-to)130-134
Number of pages5
JournalEuropean Journal of Internal Medicine
Volume11
Issue number3
DOIs
StatePublished - Jun 2000
Externally publishedYes

Keywords

  • Bromocriptine
  • DHEA
  • Experimental therapies
  • IVIg
  • MMF
  • SCT
  • SLE

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