Addressing challenges in disease management of childhood-onset systemic lupus erythematosus: the role of biologics, with a primary focus on rituximab and belimumab

INTRODUCTION: Childhood-onset systemic lupus erythematosus (cSLE) accounts for 15-20% of all forms of SLE. It is associated with greater disease severity and requires more aggressive treatment than adult-onset SLE. Despite therapeutic advances, many patients do not achieve sustained remission, highlighting the need for more effective treatment strategies. AREAS COVERED: This review summarizes the literature published in the past two decades on the use of biologic medications for the treatment of cSLE. It is based on the narrative analysis of recent clinical trials, observational studies and patient series or individual clinical cases. We discuss the rationale, indications, effectiveness and safety of the biologic agents utilized thus far in patients with cSLE, with a primary focus on rituximab and belimumab. In addition, we address the future perspectives of the management of cSLE. EXPERT OPINION: The improved understanding of the mechanisms involved in immunopathogenesis of SLE has led to the development of increasing numbers of biologic agents that target specific cells or pathways. This advance has increased the therapeutic options available for the management of cSLE and holds great promise for transforming the landscape of cSLE care through the implementation of precision medicine and personalized therapeutic approaches, with the ultimate goal of reaching sustained, glucocorticoid-free disease remission.