Iberdomide in Systemic Lupus Erythematosus Save

The NEJM reports that systemic lupus erythematosus (SLE) patients treated with iberdomide, a cereblon modulator, was effective at yielding a significant SRI-4 clinical response after 24 weeks. 

Iberdomide works by promoting degradation of the transcription factors Ikaros and Aiolos, which affect leukocyte development and autoimmunity.

A total of 288 patients were randomized to receive placebo or different doses of oral iberdomide (at a dose of 0.45, 0.30, or 0.15 mg) daily for 24 weeks, while remaining on background standard medications. The primary end point at week 24 was a response on the SLE Responder Index (SRI-4).

At week 24, the percentages SRI-4 responses were:

• Iberdomide 0.45-mg: 54%   (iberdomide 0.45-mg group vs P=0.01)
• Iberdomide 0.30-mg: 40% 
• Iberdomide 0.15-mg: 48% 
• Placebo: 35%
• No significant differences between placebo and the lower dose groups (0.30 mg, 0.15 mg)

Iberdomide-associated adverse events included urinary tract and upper respiratory tract infections and neutropenia.

Larger, longer trials are needed to determine the efficacy and safety of iberdomide in SLE.