The Promise of Hope in Lupus Nephritis

We’ve somehow reached the end of another perfectly good year, marking the coming 50th anniversary of the first pediatric rheumatology meeting in 1976, as well as the 50th anniversary of another classic, 1976’s The Bad News Bears—the timeless story of a group of lovable losers turned into baseball champions through grit and disciplined work. Over my 20 years of rheumatology training and practice, the victories in lupus nephritis research have been largely incremental and somewhat uninspiring, with progress supporting mycophenolate, calcineurin inhibitors and belimumab use measured in terms of noninferiority, improved toxicity profile and, usually, absolute differences in response rates of less than 10%. Repeated failures of rituximab for lupus nephritis in the LUNAR and EXPLORER trials left us with the bitter taste of defeat and made it clear: We were going to need a montage!

Cue the Rocky music, abandon the baseball analogy, and pick up this special supplement to The Rheumatologist, highlighting improvements in lupus nephritis and promising treatments on the horizon that will leave you on your feet. Ruth Jessen Hickman, MD, sets the stage with a summary of the Dubois Memorial Lecture, delivered by Shaun Jackson, MD, PhD. Dr. Jackson outlined how our prior B cell-driven approach has fallen short of addressing all the autoreactive B cells of interest, and the promise of new CAR T-driven B cell targeting that reaches lymphoid compartments.

Deborah Levenson presents the second act of B cell-directed therapy, with successes using obinutuzumab in the NOBILITY and REGENCY trials pushing primary response end points near 50%.

Jason Liebowitz, MD, FACR, highlights work by Andrea Fava, MD, identifying the role of often-overlooked granulocytes in lupus nephritis, and provides a behind-the-scenes look at urine-based diagnostics that gets closer to the action without any discussion of long needles.

Before we get too self-congratulatory, Michelle Petri, MD, MPH, MACR, outlines the rationale for moving the bar on measuring success in lupus nephritis, and Shivani Garg, MD, PhD, reminds us not to forget the classics, specifying hydroxychloroquine.

In the ACR Review Course, Stacy Ardoin, MD, MHS, reminds us of other important aspects of patients’ experiences to monitor in managing lupus. With the surge of recent successes in lupus nephritis management and a promising crop of upcoming CAR T-driven treatments, it’s a good time to jump on the treatment bandwagon.

Colin B. Ligon, MD, MHS, is a clinical rheumatologist with Penn Specialty Practices Pottstown, Pennsylvania, and the physician associate editor of The Rheumatologist. He previously worked at the University of Pennsylvania as co-director of the Sarcoidosis Center.