Daphna Paran MD and Yaakov Naparstek MD
In the past decade we have witnessed a dramatic change in the management of autoimmune diseases, such as rheumatoid arthritis and spondyloarthropathies, due to the development of new biologic drugs designed to target key mediators in the autoimmune process. However, the development of similar target-specific drugs for the management of SLE has not been as successful. The B cell has long been considered central to the pathogenesis of SLE and has been regarded as an important target for biologic drugs. Several B cell-targeted drugs have been developed and although the mechanisms seem promising, most of the studies published to date have failed to achieve their primary endpoints, leading to an ongoing debate regarding the role of B cell therapy in SLE. The present report discusses the pros and cons of B cell-targeted therapy in SLE, reviews the clinical studies, and offers possible explanations for the discrepancies between randomized control studies and real-life experience.