SLE Treatment Landscape: Abundance or Overload?

Imagine a world where the multiple drugs in Phase 2 and 3 trials actually get approved, and we get access to them? I know you may be thinking that I am overly optimistic, but there are so many drugs in development in lupus that we may have true difficulty choosing what to use.

A bit of a deep dive…

The JAKi are in phase3 non renal SLE trials:
Decuravacitinib 3mg bid
Upadacitinib 30 mg daily
Failure of Phase 3 Baricitinib

Many drugs that alter B cells and B cell signalling (in addition to Belimumab):
Ianalumab
Obintuzumab
Telitacicept
CAR-T (CD 19 or 20)

CD40Li – completed 1st of 2 phase 3 RCTs
Dapirolizumab pegol - CD40 ligand (CD154) is a protein expressed on surface of activated T cells, esp T helper cells (CD4+ T cells) which interacts with CD40 receptor (on B cells and other antigen-presenting cells).

S1P1R modulator
Cenerimod

IFN Type 1 alpha inhibition
Anifrolumab Approved

Dendritic cell target
Litifilimab – which targets BDCA2 (protein found on plasmacytoid dendritic cells) for cutaneous lupus

Toll like receptor 7,8 inhibition
E6742

Bispecific T cell engagers
Bispecific T-cell engagers (BiTEs) - bispecific antibody linking T cells to other cells to trigger immune therapy against other cells (initially cancer cells in older studies)

And even more mechanisms. So, we may have a wealth of choices.

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