Biologics as treatment for systemic lupus: great efforts, sobering results, new challenges.

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by specific organ manifestations and the production of autoantibodies to nuclear antigens. SLE can induce severe organ damage and carries the risk of fatal outcome. During recent years, no major progress has been made regarding new treatment options except for the introduction of mycophenolate mofetil. Therefore, the results of several large clinical trials using biological agents for treatment of SLE were hopefully awaited. Yet, the application of abatacept, belimumab and rituximab, respectively, to non-renal or renal lupus patients surprisingly has not been successful. Other studies using different agents have not been completed yet. Nevertheless, the results available so far will have a significant impact on the design of future clinical trials and will stimulate the debate on new targets for treatment of SLE.