New developments and future directions in the management of systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder with a pathogenesis that includes aberrant interactions between the innate and adaptive immune systems. Dominant pathogenetic axes include the type I interferon pathway and loss of tolerance in B cell/plasma cell development with autoantibody formation. The disease is clinically and pathogenetically heterogeneous, which has hampered the conduct of clinical trials and the development of novel therapies. Nevertheless, since the 2011 Food and Drug Administration (FDA) approval of belimumab for SLE, there has been an explosion of clinical trials that has led to the approval of anifrolumab for SLE as well as belimumab, voclosporin, and obinutuzumab for lupus nephritis. At the same time, multiple drugs with important new targets have progressed through phase 1-3 clinical trials, promising improved outcomes. In this review, we focus on new and emerging treatments over the last few years and discuss their potential impact on developing new directions in lupus management.