B cell-targeted therapies in systemic lupus erythematosus: Current status and perspectives

Systemic lupus erythematosus (SLE) is a chronic, systemic autoimmune disease. Its pathogenesis is characterized by excessive autoantibody production, immune complex deposition, and damage to multiple organs. Currently, clinicians use immunosuppressants and glucocorticoids to treat SLE; however, the overall treatment outcomes remain suboptimal. Certain patients show a poor response to these traditional drugs and long-term medication can cause extensive immunosuppression, heightened susceptibility to infections, and osteoporosis. Consequently, the demand for more efficient and safer targeted treatments for SLE is pressing. B cells are crucial to the immune system and significantly influence the development and progression of autoimmune diseases. Studies have demonstrated that the excessive proliferation and activation of autoreactive B cells, which drive the production of multiple autoantibodies, constitute a critical mechanism in the pathogenesis of SLE. In recent years, therapies have been aimed at inhibiting B cell activation and proliferation as well as to reducing the production of pathogenic autoantibodies. To date, various therapeutic approaches targeting B-cell, including targeting B-cell surface antigens, targeting B cell-stimulating factors, blocking co-stimulatory molecules, and regulating B cell signaling pathways have emerged. Despite notable advances in B cell-targeted therapies, two persistent challenges hinder their clinical translation: the heterogeneity of efficacy and off-target effects of B cell targeted therapy. To overcome these limitations, current research efforts are increasingly prioritizing the optimization of target selection and pharmacological design. These strategies aim to achieve sustained disease remission and functional restoration in SLE through three synergistic approaches: molecular discovery through technological innovation, combination therapy integration, and patient-tailored precision medicine methodologies. Here, we summarize the latest research findings and clinical applications of B cell-targeted therapy in SLE, aiming to provide valuable insights and references for improving clinical treatment strategies.