ACR CONVERGENCE 2021—More than 200 research abstracts related to lupus were accepted for presentation at ACR Convergence 2021 in November. Specific topics varied greatly. We don’t have the space to discuss many abstracts, but below, I have tried to touch on a number of different areas discussed at the meeting.
Abstract 1735—Glucocorticoid discontinuation in patients with systemic lupus erythematosus with prior severe organ manifestation1
Research by Nakai T, et al.
Glucocorticoids, such as prednisone and prednisolone, are highly effective agents for the treatment of systemic lupus erythematosus (SLE), but they come with significant toxicity that can lead to organ damage. Tapering glucocorticoids is always a goal of therapy, but this goal is frequently not met because of concerns that disease will flare. However, the study by Nakai and colleagues demonstrates that glucocorticoids can be tapered and discontinued even in patients who have had prior severe organ manifestations. Indeed, the rate of flare after discontinuation of glucocorticoids was similar in patients with or without severe organ manifestations.
Among factors that could influence flare, the presence of antibodies to Sm/ribonucleoprotein (RNP) showed a negative influence on flare-free remission; in contrast, anti-DNA antibody on the day of discontinuation of glucocorticoids did not have an effect.
In addition to indicating the feasibility of glucocorticoid discontinuation, this study is important in highlighting the role of anti-Sm/RNP antibodies in promoting pathogenesis; this role likely relates to the formation of immune complexes that induce interferon and subsequent downstream effects of this cytokine. Future studies will hopefully identify biomarkers to better determine patients for whom glucocorticoid discontinuation is possible.
Abstract 1463—Use of telemedicine for follow-up of lupus nephritis in the COVID-19 outbreak: The 6-month results of a randomized controlled trial2
Research by So H, et al.
The COVID-19 pandemic has had an enormous impact on the healthcare delivery system, arising from the care of patients with the infection, as well as those patients with other conditions whose care is affected by access issues and a reluctance to enter facilities with infected patients. Recognizing the importance of social distancing to limit contact with the virus, many hospitals and practices instituted the use of telemedicine to keep patients safely at home for routine visits. This approach was rapidly adapted in the midst of a severe public health emergency, leaving many unknowns about telemedicine’s effectiveness and impact on patients.
A single-center, randomized, open-label study by So et al. shows that the use of telemedicine for patients with SLE can lead to better patient satisfaction, as well as improved short-term outcomes, although those patients using telemedicine had more hospitalizations.