The Future of Systemic Lupus Erythematosus Treatment: The Promise of Selective Immunotherapies, Anifrolumab and Belimumab, Compared to Blanket Immunosuppressives

Lupus, also known as systemic lupus erythematosus (SLE), is a chronic autoimmune disease that can lead to inflammation and damage to multiple organs and tissues in the body. The symptoms vary from patient to patient, which makes the disease manifest very differently, resulting in difficulty in diagnosing and treating patients. Some may experience fatigue, hair loss, joint pain, and more. In the past, a general approach of blanket immunosuppression was commonly used to treat lupus. These immunosuppressive drugs would broadly target the immune system and focus on reducing symptoms. However, recent research has shown that selective immunotherapies such as monoclonal antibodies (anifrolumab and belimumab) which target specific components of the immune system are more effective in managing lupus because of their ability to reach specific cells in the immune system rather than easing symptoms. Anifrolumab blocks the activity of type I interferons, while belimumab neutralizes BLyS to reduce the production of autoantibodies, the root cause of SLE.¹⁻² This paper will introduce the immunology of the disease, explore how the more traditional approach of blanket immunosuppressive drugs work compared to the newer selective immunotherapies, and review the results from the clinical trials of anifrolumab and belimumab.