Patients with lupus ‘not doing as well as we would like’ despite new therapies
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SAN DIEGO — New drugs for the management of systemic lupus erythematosus and lupus nephritis may help bridge the gap of current unmet needs among patients, according to a speaker at the Congress of Clinical Rheumatology West.
“There are different ways to look at unmet needs in lupus,” Richard A. Furie, MD, of Northwell Health, in New York, told attendees during the hybrid meeting. “If you go back to the 1940s, the outlook for a patient with lupus was absolutely terrible.”
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Citing a study published by Tektonidou et al, Furie noted that the 7-year mortality rate among patients with lupus was 50% in 1950.
“But still, in the modern era, we are losing about 15% to 20% of our patients,” Furie said, noting that the decrease in mortality is less than the age-standardized mortality rate. “If you look at patients with lupus nephritis, our complete response rates are about 40%, so the majority of our patients are not doing as well as we would like.
“We have unmet needs in lupus nephritis, we have unmet needs in severe extra-renal disease, and the name of the game with any disease is to prevent damage,” he added.
In addition to disease activity, damage can also originate from the therapies intended to alleviate damage. Steroids are one major source of therapy-derived damage, Furie said.
New drugs, including anifrolumab (Saphnelo, AstraZeneca), belimumab (Benlysta, GlaxoSmithKline) and voclosporin (Lupkynis, Aurinia Pharmaceuticals), may offer answers in aiding patients with SLE or lupus nephritism, he added.
“Going back to anifrolumab, there were inconsistent SRI results, but we saw robust and consistent BICLA responses across studies,” Furie said.
Regarding safety, a signal for herpes zoster was present. To counter this, Furie recommended patients receive one dose of the shingles vaccine before beginning anifrolumab.
Belimumab has also demonstrated benefits in patients with SLE as well as lupus nephritis.
“The safety profile has been excellent for belimumab,” Furie said. However, he also noted that it takes longer than anifrolumab or voclosporin to become effective.
Voclosporin, meanwhile, has shown consistent results across studies and tends to work more quickly than belimumab, Furie said.
“Hopefully this is just the beginning of successes in our drug development studies,” Furie said. “I think the future is very bright for our patients with lupus.”
Regardless of drug research, some of the biggest issues facing patients with SLE and lupus nephritis will be nonadherence and noncompliance, he added.
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Furie RA. How do new drugs fit into the current treatment of SLE? Presented at The Congress of Clinical Rheumatology West; Oct. 20-23, 2022 (hybrid meeting).
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