**Abstract**

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease. It is characterized by a variable clinical course ranging from mild to fatal disease. It can affect the kidneys. The aim of treatment in SLE is the prevention of flares and the prevention of accumulation of damage to the main organs affected as well as the prevention of drug side effects. The cornerstone of SLE treatment is hydroxychloroquine. Corticosteroids are used both as induction treatment in disease flares as well as in small doses as maintenance treatment. Immunosuppressants, such as azathioprine, methotrexate and mycophenolate mofetil are used as steroid sparing agents. Calcineurin inhibitors, namely tacrolimus and cyclosporin A may also be used as immunosuppressants and steroid sparing agents. Pulse methylprednisolone, along with mycophenolate mofetil and cyclophosphamide are used as induction treatment in lupus nephritis. Rituximab, an anti-CD20 biologic agent may be used in non-renal SLE. In patients insufficiently controlled with hydroxychloroquine, low dose prednisone and/or immunosuppressive agents, belimumab may be used with beneficial effects in non-renal disease and lupus nephritis.

**Keywords:** systemic lupus erythematosus, treatment, hydroxychloroquine, corticosteroids, mycophenolate mofetil, rituximab, belimumab

## **1. Introduction**

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease affecting many organ systems. It has a variable course, ranging from a mild course to severe fatal disease. It affects mainly women in the reproductive age. Women of African or Asian origin suffer frequently and present with more severe disease. The treatment of SLE is in the focus of scientific interest as new immune modulating agents have entered the management of the disease.

The therapeutic management of the disease depends mainly on antimalarial agents, namely hydroxychloroquine, corticosteroids, immunosuppressive agents and biologic drugs (**Figures 1** and **2**). The use of hydroxychloroquine is established in SLE. Similarly, the use of corticosteroids has been in the mainstream of lupus treatment for many years. Their use is hindered by their adverse effects, which may occur even with small doses. Immunosuppressive agents such as azathioprine and methotrexate have been used as steroid sparing agents. The use of mycophenolate mofetil (MMF) is also in the mainstream treatment of severe SLE cases or lupus nephritis. Rituximab, an antiCD20 antibody targeting B lymphocytes has also been

#### **Figure 1.**

*Agents involved in systemic lupus erythematosus treatment.*

**Figure 2.** *Agents contributing to the treatment of lupus nephritis.*

applied in the treatment of severe SLE cases. Recently, the use of belimumab has been introduced in the treatment of SLE and is indicated in patients with nonrenal disease and renal disease not responsive to standard treatment. Although, recent advances in treatment have improved prognosis and life expectancy in lupus patients, much progress remains to be achieved. In the present chapter, the use of various treatment modalities for SLE will be discussed. Additionally, the use of supplementary drugs will be reviewed.
