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Promising new therapies in SLE

Md Yuzaiful Md Yusof, MRCP(UK), PhD May 31, 2023

The pharmacology treatment in SLE is a rapidly expanding field of research that provides excitement and optimism to both the patients and the clinicians. We now have three licensed targeted therapies (belimumab and voclosporin in active lupus nephritis and anifrolumab in non-renal SLE) over the last 3 years compared to one therapy (belimumab in non-renal SLE) in the previous 50 years. What are other promising therapies on the horizon?

The interface between cutaneous lymphoma and lupus panniculitis, characteristic differences and diagnostic algorithm, Eviatar T, #EULAR2023 @RheumNow https://t.co/HRTQWS4Ctq

#EULAR2023 #POS0120 From Sjogren to SLE. Interim analysis of Phase 2 RCT showed primary endpoint, SRI-4 + ability to sustain pred dose to ≤5 mg/d or ≤ BL from Wk16 to 28 was achieved more in Ianalumab (Bcell depletion & BAFF-R-i) vs PBO (44% vs 9%). Advance to Phase 3 @RheumNow https://t.co/Wg29uj5yqv

#EULAR2023 #POS0116 How does Voclosporin fare in #lupus pts with heavy proteinuria (=>2g/day)? Pooled Analyses from Phase 2&3 RCTs showed consistent improvement in renal response regardless of demographics or clinical characteristics. An option this resistant group @RheumNow https://t.co/AmZ0fStJrW

#EULAR2023 #POS0115 Can we minimise placebo response in #lupus trials? Post-hoc analysis of Phase 2 RCT Dapirolizumab (CD40-CD40L-i) showed greater response in acute flare with Normal Complement levels in the PBO group. Could Low Complement be used for trial entry? @RheumNow https://t.co/8aRq5tWi97

#EULAR2023 #OP0142 From #Lupus to #Sjogren. A phase 2 RCT in China showed more patients on Telitacicept (BAFF/APRIL-i) achieved significant reduction in ESSDAI at Wk24 vs PBO. Trend to improvement in glandular function. Intriguing option & will await Phase 3 global RCT @RheumNow https://t.co/BCiohuAfP3

#EULAR2023 #OP0141 CAR T cell therapy to treat refractory #lupus took centre stage in 2022. Up to 2yrs data on 7 patients showed continued drug-free remission despite repopulation of naive B cells. No safety concerns. Intriguing to learn even longer-term follow-up @RheumNow https://t.co/lINDT32VBj

#EULAR2023 #OP0139 Should we aim for dual blockade in #lupus? A Phase 2 RCT showed more patients on ABBV-599 HD (elsubrutinib (BTK-i) + Upadacitinib (JAK-i)) and UPA monotherapy met primary & secondary endpoints vs Placebo at 48Wks. No major malignancy or VTE concerns @RheumNow https://t.co/HEUbkzZwyl

#EULAR2023 #OP0137 Most impressive Delta difference vs Control in #lupus! In Phase 3 RCT in China, more patients in Telitacicept, BAFF/APRIL-i met SRI-4 (delta 44% if data imputed; 34% without) vs placebo. No major safety. Global Phase 3 RCT is in progress @RheumNow https://t.co/DUFRQ7pNUA

#EULAR2023 #OP0136 New Biomarkers in #lupus nephritis? Indoxyl sulfate and cytosine metabolite serum levels were associated with kidney damage but not SLEDAI and reduced following therapy with anifrolumab in Phase 2 RCT @RheumNow https://t.co/URiKx9rmmU

#EULAR2023 #OP0046 With more effective therapies in #lupus, we should aim for bare minimum/cessation of steroid. A study using French database showed: >12% were on =>5mg Pred/d, this associated with comorbidities & increased costs 14% on high dose Pred weren’t on HCQ @RheumNow https://t.co/x99Jt9yf1g

#EULAR2023 #OP0007 What are the recent trends of autoimmune disease (AID)? A database study (22m) in UK showed: - 1 in 10 people had AID in the last 20yrs - socioeconomic, seasonal & regional disparities cd influence pathogenesis - CTD (SLE,pSS,SSc) tended to co-occur @RheumNow https://t.co/3DDPR2K5NC

Medication adherence in #lupus - assessed using Optum administrative database 14 yrs. 12510 pts. Median copays were less than $ 10. Black and hispanics had significantly lower odds of adherence after adjusting for several SDOH! @rheumnow #EULAR2023 abst#AB0579 https://t.co/pO5tjzTPbz

Recruitment in clinical trials is tough in #lupus and #CTD. A #EULAR2023 study of 49 trials, 1909 records- in an unselected, real world cohort of #CTD pts, upto 50% would be excluded due to classification criteria or overlapping features etc! Abst#op0013 @RheumNow https://t.co/X3YuvgSVzo

#EULAR2023 #OP0052 Could we predict renal flares in #lupus patients treated with Belimumab for non-renal purpose? Post-hoc analyses of 3 x RCTs showed predictors were: - Current/former renal involvement - high baseline proteinuria - hypoalbuminaemia - low C3 @RheumNow https://t.co/vylWCf0XNy

RheumNow’s expanded coverage of the #EULAR2023 annual meeting is sponsored in part by Bristol Myers Squibb. All content is chosen by RheumNow and its faculty.

#EULAR2023 #OP0053 Baricitinib in non-renal #lupus were inconclusive. How about Renal #SLE?An RCT showed primary endpoint (=>50% reduction in proteinuria) was met more in Bari vs Cyclo at Wks12 & 24. Intriguing but need longer-term, composite endpoint and larger size! @RheumNow https://t.co/z3YJog6gTy

#EULAR2023 Could we predict renal flares in #lupus patients treated with Belimumab for non-renal purpose? Post-hoc analyses of 3 x RCTs showed predictors were: - Current/former renal involvement - high baseline proteinuria - hypoalbuminaemia - low C3 @RheumNow https://t.co/bBtBm1olcr

Nathalie Conrad, Abstr#OP0007 @RheumNow presenting on the incidence, prevalence and co-occurrence of autoimmune disease - no evidence of overall increase in conditions. Environmental and socioeconomic factors involved in the presentation of the conditions https://t.co/3jy9NoltkG

#EULAR2023 #OP0051 4-year Pooled Analyses of 3 x Anifrolumab RCTs in #lupus (inc. LTE) showed: - LLDAS was attained earlier & more cumulative time was spent in LLDAS in anifrolumab compared to placebo groups Assuring longer-term data *sorry photos weren’t permitted @RheumNow

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Promising new therapies in SLE

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