Advances in the treatment of systemic lupus erythematosus

Systemic lupus erythematous is a clinically and pathogenetically heterogeneous disease that has long challenged researchers and clinicians aiming to improve its treatment. Advances over the past 75 years have revealed a number of key immune mechanisms that drive clinical manifestations, paving the way for the development of therapies that go beyond broad immunosuppression to improve clinical efficacy and reduce side effects. These include approaches aimed at specific immune pathways, and emerging efforts to restore immune homeostasis, such as chimeric antigen receptor T cell therapies to eliminate pathogenic B cells, low-dose interleukin 2 or regulatory T cell therapies. Although hopes for durable remissions or cure are rising, major obstacles remain owing to the complex nature of the disease. In this Review, we discuss emerging therapeutic strategies designed to address these challenges.