What is the interest of biotherapy in lupus?

The term biotherapy is replaced by biomedicine or even simply “biologics”. This is a drug produced by living cells (hence bio) that are programmed to synthesise an antibody (monoclonal) or a fusion protein. These immunomodulatory biomedicines are widely used in inflammatory rheumatism (rheumatoid arthritis,...), inflammatory bowel disease (Crohn's), psoriasis and multiple sclerosis.

A biomedicine is an immunosuppressant that will act on a very precise "biological" target. This target is specifically chosen because it intervenes in the mechanisms of autoimmune diseases. For example, the major role of B lymphocytes as well as the type I interferon pathway has been shown in lupus.

Belimumab works by reducing the activity of self-reactive B lymphocytes. This treatment can be used in children from 5 years of age. Belimumab, can be used as a monthly IV perfusion or as a weekly subcutaneous injection. It is the first biomedicine to be

approved for use in systemic lupus. Its effectiveness is recognised in particular on skin and articular forms of the disease and in cases of proliferative kidney damage, but has not been evaluated in case of brain involvement. It is therefore not recommended for this type of lupus at the moment.

Other anti-B lymphocyte molecules such as rituximab are used in some difficult forms of lupus, but other avenues are being developed, in particular the blocking of T and lymphocytes.

Anifrolumab is a monoclonal antibody that blocks the activity of type I interferon receptors, modulating the often increased interferon response in systemic lupus, which is associated with increased disease activity and severity. Anifrolumab can be used as an add-on therapy for the treatment of adults with moderate to severe systemic lupus erythematosus (SLE) that is active, despite receiving standard therapy.

Today, there are more than fifty different biomedicines being studied in lupus, which will certainly profoundly change therapeutic strategies in the future.



In lupus, biotherapy is a biomedicine that has a "targeted" action, directed against a biological "actor" of the immune response. This target can be a cell (such as B lymphocyte) or a cytokine (such as interferon). Many biotherapies are being evaluated in lupus.

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