SYSTEMIC LUPUS ERYTHEMATOSUS – PAST, PRESENT AND EMERGING THERAPIES

Abstract

Background Systemic lupus erythematosus (SLE) is a chronic, multisystem autoimmune disease characterized by immune dysregulation, autoantibody production, and immune complex-mediated tissue damage. Despite advances in disease management, SLE remains associated with substantial morbidity, increased mortality, and significant therapeutic challenges. Objective This narrative review summarizes the current understanding of SLE epidemiology, pathogenesis, diagnosis, and treatment, with a particular focus on established therapeutic strategies and emerging treatment modalities. Methods A comprehensive literature search was conducted using publicly available scientific databases. Clinical guidelines, systematic reviews, meta-analyses, and original research articles were selected based on their relevance to SLE pathogenesis, diagnosis, and treatment. Results Current management of SLE aims to achieve remission or low disease activity through the use of hydroxychloroquine, glucocorticoids, conventional immunosuppressive agents, and targeted biologic therapies, including belimumab and anifrolumab. Improved understanding of SLE immunopathogenesis has facilitated the development of novel therapeutic approaches. Among these, hematopoietic stem cell transplantation and chimeric antigen receptor (CAR) T-cell therapy have demonstrated encouraging results in patients with severe or treatment-refractory disease. However, their widespread implementation is currently limited by safety concerns, treatment-related toxicity, high cost, limited clinical experience, and the absence of long-term efficacy and safety data. Conclusions Although recent therapeutic advances have improved clinical outcomes in SLE, many patients continue to experience refractory disease and treatment-related complications. Emerging therapies offer the potential for more targeted and durable disease control, but further large-scale clinical studies with extended follow-up are required to establish their long-term efficacy, safety, and place in future treatment algorithms.