Division of Rheumatology, Department of Medicine, University of Padova, Padova, Italy.
Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain.
Autoimmun Rev. 2017 Nov;16(11):1119-1124. doi: 10.1016/j.autrev.2017.09.006. Epub 2017 Sep 9.
Biologic therapy is still limited in lupus, where chronic steroid exposure and wide-spectrum immunosuppression are major triggers of organ damage. In this viewpoint, the authors summarize their views for a "half-full or half-empty" glass on targeted therapy in SLE. The are several reasons for seeing the glass half-empty and in this section the authors propose a critical reflection on scarceness of novel targeted lupus therapies. They show how hard it is to identify suitable biological and clinical targets and to choose the patients that may best fit those targets, as well as to stratify patients according to disease subtype and response, all contributing to the final outcome. On the other hand, reasons are emerging to see the glass half-full, including the growing evidence that disease activity and damage can both be hindered by the proper use of novel drugs and that promising molecules are upcoming. In this section, the authors contextualize potentials and failures of new drugs, providing a critical reading of disappointing results and underlining the concrete benefits obtainable through a wise use of available treatments. Indeed, combining medications with new therapeutic strategies such as the treat-to-target seems the right approach to add some water to a filling glass.
生物疗法在狼疮中仍然受到限制，慢性类固醇暴露和广谱免疫抑制是导致器官损伤的主要因素。在这篇观点文章中，作者总结了他们对靶向治疗 SLE 的“半满或半空”的看法。有几个原因导致我们看到杯子半空，在这一节中，作者对新型靶向狼疮治疗方法的缺乏提出了批判性的反思。他们展示了如何难以确定合适的生物学和临床靶点，并选择可能最适合这些靶点的患者，以及根据疾病亚型和反应对患者进行分层，所有这些都对最终结果产生影响。另一方面，也有理由看到杯子半满，包括越来越多的证据表明，新型药物的正确使用可以同时抑制疾病活动和损伤，并且有前途的分子即将出现。在这一节中，作者将新药物的潜力和失败置于背景下，对令人失望的结果进行了批判性的解读，并强调了通过明智地使用现有治疗方法可以获得的具体益处。事实上，将药物与新的治疗策略（如靶向治疗）相结合，似乎是为一个装满水的杯子再添一些水的正确方法。
