<p>Treatment options for SLE have improved in recent years. Basic research, clinical studies, and epidemiological studies worldwide have contributed to this progress. Recent international recommendations and guidelines show broad agreement on how SLE should be treated. The findings of many studies play an important role in this regard, as they show that a large percentage of patients experience irreversible organ damage at an early stage. Organ damage, treatment toxicity, especially from glucocorticoids, and disease activity are closely related. This has led to the development of a “treat to target” treatment principle, which aims to halt this organ damage through early, targeted treatment that suppresses disease activity. Important treatment goals are either remission or at least low disease activity. Clinical studies have provided particularly good evidence of a significant reduction in organ damage for the two biologics belimumab and anifrolumab, as well as for hydroxychloroquine. According to the 2023 EULAR recommendations, belimumab and anifrolumab can be used in individual cases even with mild to moderate active SLE. General measures targeting comorbidities, among other things, should be taken into account, as should providing patients with the best possible individualized information. Many new substances with completely different modes of action are currently in various stages of clinical development. In addition, once the initial data have been confirmed, CAR-T cell technology, which has so far primarily targeted deep B-cell depletion, might be available in the future for therapy-resistant cases.</p>