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Speakers: Lupus Remains Challenging Disease
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Healio Rheumatology recently interviewed Richard Furie, MD, from Hofstra Northwell School of Medicine, Lars Rönnblom, MD, from Uppsala University in Sweden, and Mary K. Crow, MD, from Hospital for Special Surgery, about the future of lupus during the Interferon Summit.
“We need better drugs,” Furie said. “There is a major need for safer and more efficacious therapies. The typical patient who gets this disease is a young woman and it can be devastating.”
To illustrate the need for better therapies, Furie discussed the progression of treatments for the disease.
“We have come a long way with treatments,” he said. “If you go back before steroids were developed, the mortality was high. It was probably 50% at 7 years, but steroids were introduced and they have been a major advance. Then, after that, it was the immunosuppressives; but, until we get rid of all mortality and morbidity, we need new drugs.”
To derive better therapies for a disease, there needs to be better disease classification. Rönnblom talked about the current classification of lupus patients and how to treat the underlying cause vs. a cluster of symptoms.
“We classify patients with an auto[body] or antibody profile,” Rönnblom said. “In lupus, we classify them according to organ manifestation, but also when they have this interferon signature. My guess is that we will see more pathways coming up. Much of this data will be generated by the clinical trials, of course, who responds and who does not respond.”
Crow said better understanding about the molecular pathway and underlying mechanisms of the disease can lead to better therapy.
“My own speculation is that we will probably end up with combination therapies and maybe combinations will allow us to use lower doses, each of one or two or three therapies to avoid toxicity. For example, we might want to target this type 1 interferon pathway that I believe is active in a sustained way throughout the disease, but may be more important in some stages than others,” she said.
“To have a more effective therapeutic activity, we might also want to target activated T cells or B cell differentiation. My guess is that we, as a community, will end up trying different combinations and some of the selection of those might be informed by the molecular pathways that an individual shows to be activated or abnormal.” – by Will A. Offit
Disclosures: The researchers report no relevant financial disclosures.