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An official publication of the ACR and the ARP serving rheumatologists and rheumatology professionals

Difficult-to-Treat Lupus: When & How to Use New Therapies

  |  Issue: September 2022  |  

Final Thoughts

SLE patients have heterogeneous manifestations of disease, and our SLE toolbox is beginning to match that diversity. When selecting a therapy, Dr. Aringer reminded us that not all SLE symptoms represent active autoimmunity, and therapies often need months to work. He concluded, “Take the individual SLE organ spectrum into account when choosing a drug. Be aware of the risks and uncertainties of off-label therapy, while bearing in mind that these patients need help, and there isn’t a lot that’s formally approved just yet.”

Samantha C. Shapiro, MD, is an academic rheumatologist and an affiliate faculty member of the Dell Medical School at the University of Texas at Austin. She is also a member of the ACR Insurance Subcommittee.

References

  1. Fanouriakis A, Kostopoulou M, Alunno A, et al. 2019 Update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis. 2019 Jun;78(6):736–745.
  2. Ordi-Ros J, Sáez-Comet L, Pérez-Conesa M, et al. Enteric-coated mycophenolate sodium versus azathioprine in patients with active systemic lupus erythematosus: A randomised clinical trial. Ann Rheum Dis. 2017 Sep;76(9):1575–1582.
  3. Strand V, Levy RA, Cervera R, et al. Improvements in health-related quality of life with belimumab, a B-lymphocyte stimulator-specific inhibitor, in patients with autoantibody-positive systemic lupus erythematosus from the randomised controlled BLISS trials. Ann Rheum Dis. 2014 May;73(5):838–844.
  4. Manzi S, Sánchez-Guerrero J, Merrill JT, et al. Effects of belimumab, a B lymphocyte stimulator-specific inhibitor, on disease activity across multiple organ domains in patients with systemic lupus erythematosus: Combined results from two phase III trials. Annals Rheum Dis. 2012 Nov;71(11):1833–1838.
  5. Stohl W, Schwarting A, Okada M, et al. Efficacy and safety of subcutaneous belimumab in systemic lupus erythematosus: A fifty-two–week randomized, double-blind, placebo-controlled study. Arthritis Rheumatol. 2017 May;69(5):1016–1027.
  6. Furie R, Khamashta M, Merrill JT, et al. Anifrolumab, an anti–interferon-α receptor monoclonal antibody, in moderate-to-severe systemic lupus erythematosus. Arthritis Rheumatol. 2017 Feb;69(2):376–386.
  7. Morand EF, Furie RA, Bruce IN, et al. Efficacy of anifrolumab across organ domains in patients with moderate-to-severe systemic lupus erythematosus: A post-hoc analysis of pooled data from the TULIP-1 and TULIP-2 trials. Lancet Rheumatology. 2022;4(4):E282–E292.
  8. Jayne D, Rovin B, Mysler EF, et al. Phase II randomised trial of type I interferon inhibitor anifrolumab in patients with active lupus nephritis. Ann Rheum Dis. 2022 Apr;81(4):496–506.
  9. Tummala R, Abreu G, Pineda L, et al. Safety profile of anifrolumab in patients with active SLE: an integrated analysis of phase II and III trials. Lupus Sci Med. 2021 Feb;8(1):e000464.
  10. Rovin BH, Teng YKO, Ginzler EM, et al. Efficacy and safety of voclosporin versus placebo for lupus nephritis (AURORA 1): A double-blind, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet. 2021 May 29;397(10289):2070–2080.
  11. Terrier B, Amoura Z, Ravaud P, et al. Safety and efficacy of rituximab in systemic lupus erythematosus: Results from 136 patients from the French AutoImmunity and Rituximab registry. Arthritis Rheum. 2010 Aug;62(8):2458–2466.
  12. Lu TYT, Ng KP, Cambridge G, et al. A retrospective seven-year analysis of the use of B cell depletion therapy in systemic lupus erythematosus at University College London Hospital: The first fifty patients. Arthritis Rheum. 2009 Apr 15;61(4):482–487.
  13. Furie RA, Aroca G, Cascino MD, et al. B-cell depletion with obinutuzumab for the treatment of proliferative lupus nephritis: A randomised, double-blind, placebo-controlled trial. Ann Rheum Dis. 2022 Jan;81(1):100–107.
  14. Eli Lilly and Company. Updates on OLUMIANT (baricitinib) phase 3 lupus program and FDA review for atopic dermatitis. 2022 Jan 28.
  15. Joos L, Vetterli F, Jaeger T, et al. Treatment of refractory subacute cuataneous lupus erythematosus with baricitinib. Clin Exp Dermatol. 2022 Apr;47(4):748–750.
  16. Cortés-Hernández J, Egri N, Vilardell-Tarrés M, Ordi-Ros J. Etanercept in refractory lupus arthritis: An observational study. Sem Arthritis Rheum. 2015 Jun;44(6):672–679.
  17. Illei GG, Shirota Y, Yarboro CH, et al. Tocilizumab in systemic lupus erythematosus: Data on safety, preliminary efficacy, and impact on circulating plasma cells from an open-label phase I dosage-escalation study. Arthritis Rheum. 2010 Feb;62(2):542–552.

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