[Systemic lupus erythematosus: new treatment targets and agents]

Management of systemic lupus erythematosus (SLE) has moved towards a defined treat-to-target approach. In April 2025 the first German S3 guideline was published, complementing the 2023 EULAR recommendations and the 2025 EULAR update on kidney involvement. All emphasize hydroxychloroquine as a backbone, a prednisolone target of ≤5mg/day and early use of belimumab or anifrolumab without any specific preference. Two validated targets guide therapy: DORIS remission (clinical SLEDAI 0, PGA <0,5, prednisolone ≤5mg/day) and LLDAS (SLEDAI-2K ≤4 without vital organ activity, PGA ≤1, prednisolone ≤7,5mg/day). Anifrolumab has been approved for subcutaneous self-administration in the EU since December 2025. Obinutuzumab, a type II anti-CD20 antibody, met its primary endpoint in the phase III trials REGENCY and ALLEGORY. Dapirolizumab pegol enabled glucocorticoid tapering alongside BICLA response in a phase III trial. Cellular approaches are advancing: autologous CD19 CAR T cells led to long-lasting remission in the refractory SLE patients, while off-the-shelf allogeneic constructs and T-cell engagers such as teclistamab or blinatumumab are in early clinical development.