Systemic Lupus Erythematosus: Current Management Strategies and Emerging Therapeutic Advances - A Narrative Review

Abstract

Context: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multisystem involvement, autoantibody production, and immune complex-mediated tissue damage. It predominantly affects women of reproductive age and presents with a broad spectrum of clinical manifestations, ranging from cutaneous disease to severe organ involvement, including lupus nephritis and neuropsychiatric complications. Advances in understanding disease pathophysiology have highlighted the roles of B-cell hyperactivity, complement activation, and type I interferon signaling. Evidence Acquisition: This narrative review synthesizes current evidence on the management of SLE, including conventional therapies, biologic agents, emerging treatments, and implementation challenges in resource-limited settings such as Pakistan. Results: Conventional therapies, including hydroxychloroquine, corticosteroids, and immunosuppressants such as azathioprine, cyclophosphamide, and mycophenolate mofetil, remain the mainstay of treatment. However, long-term toxicity and incomplete disease control have driven the development of targeted biologic therapies. Biologic agents such as belimumab and anifrolumab represent important advances in precision medicine by targeting specific immune pathways and reducing disease activity and flares. Emerging strategies, including CAR-T cell therapy and hematopoietic stem cell transplantation, further expand the therapeutic landscape but remain experimental and are limited to specialized settings. Despite these therapeutic advances, challenges such as delayed diagnosis, limited access to biologics, and high treatment costs continue to affect outcomes in resource-limited regions. Conclusions: Overall, SLE management is increasingly shifting toward personalized, targeted therapeutic approaches to improve long-term disease control and patient outcomes.