Modern therapeutic strategies for autoimmune diseases

Autoimmunity is an overreaction of immune competent cells to self structures resulting in an unwanted clinical outcome. Traditional therapeutic strategies, still relevant in many cases, involve broad acting immunosuppressants such as cyclophosphamide with the predictable attendant toxicity. More recent concepts include blockade of specifically defined targets such as TNF-α, with resulting immunomodulation and less toxicity. Both of these strategies require ongoing drug treatment of established disease. A long standing goal, not yet achieved, is the predictable induction of tolerance, obviating the need for chronic treatment. Experimental strategies to achieve this include pre-emptive (preclinical) treatment before chronification is established, total immune ablation and immune "resetting" and autoantigen immunisation.