Management strategies using biologics in systemic lupus erythematosus

Our foray into the development of novel therapies for systemic lupus erythematosus (SLE) began several decades ago. This was only possible because of the dissection of the immune system and the identification of key molecules and pathways that appeared to play roles in SLE pathogenesis. For example, although interferon was discovered in the 1950s, its association with SLE was not recognized until the late 1970s. Building upon the early observations made in autoimmune diseases, interferon inhibitors were first tested in SLE in the early 2000s. Another example is the sequencing of neutrophil libraries and the identification of a gene that encoded a protein that was subsequently named B Lymphocyte Stimulator (BLyS, also known as B Cell Activating Factor [BAFF]). These discoveries eventually led to the development of anifrolumab, an antibody to the Interferon-Alpha Receptor, and belimumab, an antibody to BLyS. Their roles in the treatment of SLE are outlined in the manuscript that follows.