{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T16:11:04Z","timestamp":1778083864763,"version":"3.51.4"},"reference-count":70,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare the efficacy and safety of biologics and targeted small molecule drugs plus stable background therapy for the systemic lupus erythematosus (SLE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search was conducted across PubMed, EMBASE and Cochrane Library for eligible randomized controlled trials (RCTs), and a network meta-analysis (NMA) was performed to investigate the efficacy and safety of biological agents and targeted small molecule drugs added to stable background therapy in SLE. The evaluation indicators included the rates of SLE Responder Index (SRI-4) response, BILAG-based Composite Lupus Assessment (BICLA) response, Cutaneous Lupus Erythematosus Disease Area and Severity Index-50 (CLASI-50), Lupus Low Disease Activity State (LLDAS), adverse events (AEs), serious adverse events (SAEs) and infection-related adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 32 studies were included, involving 17,121 patients. For SRI-4 response, Telitacicept was superior to Belimumab and Ustekinumab outperformed Epratuzumab. Upadacitinib demonstrated superior efficacy versus Baricitinib for both BICLA response and LLDAS attainment. Deucravacitinib and Anifrolumab were more effective for CLASI-50 achievement than Baricitinib. Anifrolumab, Iberdomide, and Telitacicept were associated with a higher incidence of AEs (e.g., upper respiratory tract infections, urinary tract infection, and herpes zoster) compared with other interventions, which may be related to their immunomodulatory mechanisms of action. Cenerimod was associated with the lowest risk of SAEs, and IL-2 showed the lowest risk of infection-related AEs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Telitacicept and Ustekinumab demonstrated superior efficacy for SRI-4 response; Upadacitinib superior for BICLA response and LLDAS achievement; Deucravacitinib and Anifrolumab showed advantages in CLASI-50 improvement, suggesting therapeutic potential for SLE with cutaneous manifestations. Although current findings indicate that these interventions have favorable efficacy and safety profiles, their long-term efficacy and safety still require further investigation and validation in the future.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/<\/jats:ext-link>\n                      , identifier CRD42024594766.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1739946","type":"journal-article","created":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T05:37:27Z","timestamp":1777613847000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative effectiveness and safety of biologics and targeted small-molecule therapies plus stable background therapy in systemic lupus erythematosus: a systematic review and network meta-analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Wenjuan","family":"Li","sequence":"first","affiliation":[{"name":"School of Chinese Materia Medica, Yunnan University of Chinese Medicine","place":["Kunming, China"]},{"name":"Research Center of Clinical Pharmacology, The First Affiliated Hospital of Yunnan University of Chinese Medicine","place":["Kunming, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yanhong","family":"Zhao","sequence":"additional","affiliation":[{"name":"School of Pharmaceutical Sciences and Yunnan Key Laboratory of Pharmacology for Natural Products, Kunming Medical University","place":["Kunming, China"]},{"name":"Research Center for Early Clinical Trials of Drugs (Vaccines), The Affiliated Anning First People\u2019s Hospital, Kunming University of Science and Technology","place":["Kunming, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siyan","family":"Shu","sequence":"additional","affiliation":[{"name":"Monash University, Faculty of Pharmacy and Pharmaceutical Sciences","place":["Melbourne, Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ran","family":"Li","sequence":"additional","affiliation":[{"name":"School of Pharmaceutical Sciences and Yunnan Key Laboratory of Pharmacology for Natural Products, Kunming Medical University","place":["Kunming, China"]},{"name":"Research Center for Early Clinical Trials of Drugs (Vaccines), The Affiliated Anning First People\u2019s Hospital, Kunming University of Science and Technology","place":["Kunming, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Huang","sequence":"additional","affiliation":[{"name":"Research Center of Clinical Pharmacology, The First Affiliated Hospital of Yunnan University of Chinese Medicine","place":["Kunming, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuanyuan","family":"Gong","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, 920th Hospital of Joint Logistics Support Force","place":["Kunming, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guanhua","family":"Zhao","sequence":"additional","affiliation":[{"name":"Research Center of Clinical Pharmacology, The First Affiliated Hospital of Yunnan University of Chinese Medicine","place":["Kunming, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuxin","family":"Fan","sequence":"additional","affiliation":[{"name":"Research Center of Clinical Pharmacology, The First Affiliated Hospital of Yunnan University of Chinese Medicine","place":["Kunming, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianchang","family":"He","sequence":"additional","affiliation":[{"name":"Research Center of Clinical Pharmacology, The First 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