California Rheumatologists Explore Managed Care, Treatment Options

There has also been progress in understanding how to administer pulse cyclophosphamide (CTX), another conventional therapy for SLE, Dr. Wofsy said. The recent Euro-Lupus Nephritis Trial (ELNT), conducted in Europe, concluded that low-dose treatment with pulse CTX was just as effective as high-dose treatment, and with fewer infections.¹¹ To date, there has been reluctance in the U.S. to generalize from its results, he noted, largely due to concerns that low-dose CTX might not be as effective in racial and ethnic minorities in the U.S. To address this concern, UCSF has been studying the effects of the ELNT regimen in diverse populations.

The recent approval of belimumab, a monoclonal antibody that inhibits B-cell function, has generated great excitement in the lupus community, Dr. Wofsy said. Two trials have demonstrated its benefits in lupus patients with diverse manifestations of the disease, but further studies are currently in progress to determine which manifestations of lupus, and which patient subpopulations, might benefit most from this therapy. Numerous other biologic therapies are currently under investigation, he said.

Larry Beresford is a freelance journalist based in California.

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