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Hi everyone, I'm Melissa Axelrod, a rheumatology fellow at Columbia reporting from RheumNow from ACR Convergence 2026.
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Today I'm going to discuss abstract 0273, which examines glucocorticoid reduction with abelacimab in the phase 3 ALLEGORY trial.
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We know that one of our biggest challenges in treating lupus is achieving disease control while minimizing chronic steroid use.
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ALLEGORY demonstrated significant improvements in disease activity with abelacimab compared with placebo, both added to standard therapy.
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This analysis specifically looked at whether patients could achieve more ambitious glucocorticoid targets.
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Among patients entering the trial on at least 10 milligrams of prednisone daily, approximately 73% receiving abelacimab maintained a dose of 5 milligrams or less between weeks 40 and 52, compared to 49% receiving placebo.
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And approximately 21% of abelacimab-treated patients were completely off glucocorticoids at week 52, compared with 11% receiving placebo.
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So, what do I find particularly compelling about this story?
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First, I like that we're moving beyond composite disease activity scores and focusing on outcomes that matter for long-term patient health.
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Our treatment goal isn't simply to control inflammation — it's to do so without exposing patients to yearlong glucocorticoid-related morbidity.
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Second, the sustained reduction to 5 milligrams or less was a prespecified endpoint, and the randomized trial design strengthens confidence that abelacimab contributed to the improvement.
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And importantly, the parent trial also demonstrated improvements in low disease activity, remission, and flare outcomes.
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But I think there are some limitations worth emphasizing.
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The more stringent outcomes, including complete steroid discontinuation, were exploratory and assessed at a single time point.
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And even with abelacimab, nearly 80% of patients weren't completely off steroids by week 52.
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The trial also used protocol-directed tapering and didn't specifically guide patients towards complete steroid elimination.
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So I wonder whether a more structured taper-to-zero strategy might produce different results.
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So, what's my clinical takeaway? I think these findings reinforce that steroid sparing should be a meaningful measure of therapeutic success rather than just an added benefit.
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Abelacimab appears promising in helping patients achieve disease control with less prednisolone.
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But I think the bigger goal remains sustained steroid-free remission, and we're not there yet.
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