5. Personalized therapy in SLE

SLE is actually a highly representative model for diseases that are in crucial need for personalized therapies as it is one of the highly heterogeneous and complex human diseases with chaotic pathogenesis [1, 4]. Although under the same disease umbrella, SLE patients are not homogenous cohorts that can be classified, treated, or managed equally as they show marked discrepancies in their responses to the same treatment, manifestations of disease severity, type and levels of circulating biomarkers, organ involvement, and the underlying pathogenic mechanisms that are highly influenced by genetic, environmental, and other risk factors [1, 118]. Currently, SLE patients are routinely treated with potent immunosuppressive agents that can cause adverse side effects which tend to be even more aggressive than the disease itself [41]. With the aim of achieving optimum management of SLE patients, it is therefore very wise to stratify these patients into subsets that share common pathogenic pathways which can be best accommodated with targeted or personalized therapeutic approaches that do not only increase treatment efficacy but also present safer alternatives to the nonselective immune-toxic steroids that are currently employed for the management of SLE patients [3, 118].

Recent gains in understanding SLE immunopathology have exposed certain deregulated immune trends that are now known to be common in subsets of SLE patients where some of these trends are now well characterized and paved the way for the exposure of various targets that are highly promising in personalized therapeutic approaches (Figure 6) [3]. Over the past 10 years, various medications made their way through preclinical and early clinical testing for the treatment of SLE patients, but unfortunately almost none of them was met with success during the later stages of clinical trials. This can be attributed to the highly heterogeneous nature of SLE patients which make study designs for clinical trials a very difficult mission [119, 120].

In this section of the chapter, highly promising therapeutic targets for specific subsets of SLE patients and recent therapeutic developments that hold a great potential in personalized medicine targeting specific cohorts of SLE patients will be discussed.
