Update on emerging drug therapies for systemic lupus erythematosus

Importance of the field: Despite the improvement in survival of systemic lupus erythematosus (SLE), a cure for this chronic and disabling disease is still a myth. Refractory manifestations and treatment-related complications are still major causes for mortality and morbidity. More effective but less toxic therapies through modification of existing regimens, combination strategies or more specific targeting at the immunopathogenetic pathways are necessary. Areas covered in this review: The availability of biotechnology has led to the emergence of targeted therapies for SLE. In the past 5 years, there have been a number of clinical trials in the pipeline that involve existing drugs or novel biological agents. This article updates different novel therapeutic approaches in SLE that have emerged since 2006. What the readers will gain: Readers will read the latest information and critical appraisals regarding recent clinical trials in lupus. Expert opinions on future directions of SLE treatment trials are also provided. Take home message: SLE is a clinically and immunologically heterogeneous disease. Targeted therapies are currently available but to the disappointment of the lupus community, data from many recent clinical trials are unfavorable. While flaws and limitations in the study design and outcome measures may contribute to the futility of these trials, selection of SLE subsets by serum and cellular biomarkers may identify those who will benefit from these targeted therapies.