Service de rhumatologie, hôpitaux universitaires de Strasbourg, 67200 Strasbourg, France; Université de Strasbourg, centre national de référence RESO-Lupus, 67000 Strasbourg, France; Laboratoire d'immunologie, immunopathologie et chimie thérapeutique, institut de biologie moléculaire et cellulaire (IBMC), CNRS UPR3572, 67000 Strasbourg, France.
Service de pharmacie-stérilisation, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France.
Joint Bone Spine. 2019 Jul;86(4):429-436. doi: 10.1016/j.jbspin.2018.09.004. Epub 2018 Sep 19.
There have been many advances in the diagnosis and therapeutic management of systemic lupus erythematosus (SLE) over the past decades. Following more than eleven centuries of therapeutic uncertainty, the discovery of the therapeutic properties of glucocorticoids is without any doubt one of the most significant advance in the field of autoimmune diseases. The many progresses made by rapidly growing chemical industry of the 19th century chemistry have allowed the identification of valuable therapeutic compounds such as anti-malarials, cyclophosphamide, azathioprine, cyclosporine and later mycophenolate mofetil, which have all profoundly changed the face of the disease. A very visible consequence of this is the profound improvement in the prognosis of the disease, with 10-year survival rates of more than 90% in most dedicated centres. Following the development of biotherapies in rheumatoid arthritis, the late 20th century has slowly opened a new era for the treatment of SLE, that of targeted therapies. With the approval of belimumab in 2011 and 74 targeted therapies in clinical development, we may expect great changes in the therapeutic management of SLE. Those molecules target inflammatory cytokines or chemokines and their receptors, B cells or plasma cells, intracellular signalling pathways, B/T cells co-stimulation molecules, interferons, plasmacytoid dendritic cells, as well as various other targets of interest. Current challenges are now slowly shifting from whether some new drugs will be available to how to select the most adequate drug (or drug combination) at the patient-level.
过去几十年，系统性红斑狼疮（SLE）的诊断和治疗管理取得了许多进展。在经历了十一个多世纪的治疗不确定性之后，糖皮质激素治疗特性的发现无疑是自身免疫性疾病领域的最重要进展之一。19 世纪化学工业的快速发展所取得的许多进展使人们能够识别出有价值的治疗化合物，如抗疟药、环磷酰胺、硫唑嘌呤、环孢素，后来还有霉酚酸酯，所有这些都彻底改变了疾病的面貌。由此产生的一个非常明显的后果是，疾病的预后得到了极大改善，在大多数专门中心，10 年生存率超过 90%。继类风湿关节炎的生物疗法发展之后，20 世纪后期慢慢为 SLE 的治疗开辟了一个新的时代，即靶向治疗时代。2011 年批准贝利尤单抗（belimumab）以及 74 种处于临床开发阶段的靶向疗法之后，我们可能会期待 SLE 的治疗管理发生重大变化。这些分子靶向炎症细胞因子或趋化因子及其受体、B 细胞或浆细胞、细胞内信号通路、B/T 细胞共刺激分子、干扰素、浆细胞样树突状细胞以及各种其他感兴趣的靶标。当前的挑战正慢慢从是否会有一些新药问世转变为如何在患者层面选择最合适的药物（或药物组合）。
