Title:Drugs, Trials and Pathogenesis: Will Connecting these Help us Understand SLE?
Volume: 9
Issue: 3
Author(s): Sachin Srinivasan, Sangmee Bae, Maureen McMahon and Daniel E. Furst
Affiliation:
Keywords:
B-cells, biologics, DMARD’s, systemic lupus erythematosus, treatment, pathogenesis, .
Abstract: Medications, through their mechanisms of action, can help elucidate the pathogenesis of SLE. Unfortunately,
most medications used to treat SLE have multiple mechanisms of action or are not highly specific. Nevertheless, some
understanding of SLE's pathogenesis can be derived from the medications used to treat it. Agents inhibiting B and T cells
globally such as leflunomide, mycophenolate mofetil, cyclophosphamide and azathioprine show that a global effect is
generally effective.
While limited by issues of unclear outcome measures and difficulty in study design, the usefulness of agents principally
inhibiting B-cells thru CD19/20/22, such as rituximab and belimumab, indicate that B-cell abnormalities are important in
SLE. Agents blocking B and T-cell co-stimulation such as abatacept and atacicept indicate modest but real effects, supporting
this mechanism as of some importance in SLE Agents principally inhibiting T cells such as cyclosporine and tacrolimus
also seem to have some efficacy, indicating that the calcineurin pathway is active in SLE. Transplant based therapies
and re-establishing tolerance are of interest but and are effective but their effect seems to be transient, attesting to the
highly reactive nature of the immune system in SLE. Finally, other investigational approaches such as inhibiting the IL-6
pathway (tocilizumab) or IFN pathway are being tested but results are too preliminary to make statements regarding the
importance of these pathways, or treatments, in SLE.
