Trials and Tribulations in Systemic Lupus Erythematosus (Report‪)‬

At the close of the 20th century, the best data we had to guide treatment decisions for patients with systemic lupus erythematosus (SLE) came from a handful of relatively small but nonetheless very important trials of conventional immunosuppressive therapy for lupus nephritis. (1) For other manifestations of lupus, we relied heavily on clinical judgments about the risk-benefit ratio of various agents, and on the principle that careful attention to overall physical and mental health is critically important for people with lupus (e.g., blood pressure control, prevention of osteoporosis, appropriate vaccination, psychosocial support, etc.). Even for those agents that had been subject to trials, simple questions about dose and duration of therapy had not been answered. Promising biologic therapies had not yet been tested. During the past decade, all of that has changed (Table 1). Cyclophosphamide