**2.5 Supplementary therapeutic modalities**

Recently efforts have been made to incorporate adjunct therapeutic agents in the treatment of SLE, so, as to reduce the toxicity of traditional drugs. Prasterone and vitamin D are two immunomodulatory agents, which have been applied in the treatment of SLE as supplements, in order to control disease activity and reduce the use of corticosteroids. Prasterone is a synthetic form of the hormone dehydroepiandrosterone [139]. Its use led SLE patients to better tolerate the tapering of corticosteroids [140]

**119**

**Author details**

of lupus disease.

**4. Conclusion**

Panagiotis Athanassiou1

Ifigenia Kostoglou-Athanassiou3

\*, Lambros Athanassiou<sup>2</sup>

treatment, which was tested in SLE patients with favorable results [152].

Hydroxychloroquine and prednisone remain standard of care treatment for SLE. When flares occur the introduction of immunosuppressive agents and/or biologic drugs improves disease activity and disease outcome in SLE. Nowadays, the introduction of biologic agents, such as rituximab and belimumab have revolutionized the treatment of SLE and have opened new therapeutic horizons in all the spectrum

1 Department of Rheumatology, St. Paul's Hospital, Thessaloniki, Greece

2 Department of Rheumatology, Asclepeion Hospital, Voula, Athens, Greece

3 Department of Endocrinology, Asclepeion Hospital, Voula, Athens, Greece

© 2021 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

\*Address all correspondence to: pathanassiou@yahoo.gr

provided the original work is properly cited.

and

*Novel Therapeutic Interventions in Systemic Lupus Erythematosus*

in SLE, as shown by some but not all studies [144–146].

**3. Therapeutic strategies for the management of SLE**

and stabilized disease activity in some patients [141]. Vitamin D has immunomodulatory properties, namely it decreases inflammatory cytokines and down regulates the renin-angiotensin system [142, 143]. It may lead to the improvement of disease activity

In 2014 a panel of experts introduced the treating-to-target approach in the management of SLE [147]. In 2019 an update of the EULAR recommendations for the management of SLE was published [148]. These recommendations are based both on evidence as well as on expert opinion. According to these recommendations, hydroxychloroquine should be administered to all lupus patients at a dose not exceeding 5 mg/kg real body weight. During chronic maintenance therapy glucocorticoids should be minimized to less than 7.5 mg/day and withdrawn if possible. Initiation of immunomodulatory agents can aid in tapering or withdrawal of corticosteroids. In active or flaring extra-renal disease belimumab should be considered. Rituximab is an option for organ-threatening refractory disease. Various approaches for the treatment of SLE are currently under investigation. These include various methods to target interferon I, such as the use of anifrolumab, a human monoclonal antidoy to type I interferon receptor subunit 1 [149, 150], and to inhibit T cell co-stimulation [151]. Baricitinib, an oral selective Janus kinase1 and Janus kinase 2 inhibitor is an oral

*DOI: http://dx.doi.org/10.5772/intechopen.97168*

and stabilized disease activity in some patients [141]. Vitamin D has immunomodulatory properties, namely it decreases inflammatory cytokines and down regulates the renin-angiotensin system [142, 143]. It may lead to the improvement of disease activity in SLE, as shown by some but not all studies [144–146].
