Emerging treatment strategies in systemic lupus erythematosus: integrating molecular stratification, targeted therapy, and treatment response evaluation.

Abstract

INTRODUCTION Systemic lupus erythematosus (SLE) is a complex autoimmune disease characterized by marked clinical and immunological heterogeneity. Recent advances indicate that SLE comprises multiple molecular endotypes driven by distinct immune pathways, underscoring the need for a precision medicine approach. AREAS COVERED Literature was identified through searches of PubMed/MEDLINE using keywords including 'systemic lupus erythematosus,' 'precision medicine,' 'biomarkers,' 'multi-omics,' 'lupus nephritis,' 'CAR-T,' and related terms. Landmark clinical trials, translational studies, and recent high-impact publications published through May 2026 were preferentially included. This review summarizes advances in SLE stratification based on immune phenotyping and multi-omics approaches and outlines emerging therapies, including biologics, intracellular inhibitors, and cell-based treatments. It also discusses challenges in clinical trial design and treatment response assessment. EXPERT OPINION Improving outcomes in SLE will require the integration of molecular stratification, mechanism-based therapy, and refined response assessment. However, the routine implementation of precision medicine remains limited by the lack of standardized biomarkers, accessible multi-omics platforms, and validated patient stratification algorithms. The development of standardized, clinically applicable stratification tools together with novel outcome measures will be essential for translating precision medicine into routine clinical practice.