‘Treating lupus is a war’: Victory depends on winning the small battles
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Treating patients with lupus can be likened to fighting a war, in which victory is achieved not through a single promising therapy, but winning many smaller battles, according to a speaker at EULAR 2023 Congress.
“Something that I have learned over the years is that treating lupus is a war to win,” Dimitrios T. Boumpas, MD, FACP, of the Biomedical Research Foundation Academy of Athens, in Greece, told attendees. “And you win it by winning multiple small battles every day.”
Patients with longstanding disease who demonstrate residual disease activity often represent the hardest battles, he added.
“The most challenging part of lupus, even for experienced people, is the treatment of longstanding system lupus erythematosus with residual activity and damage,” Boumpas said. “This is not easy to treat.”
As with any patient with lupus, it is important to maintain view of the big picture during treatment and remain focused on the goal of reducing flares and the damage they cause.
“You need to treat aggressively, but also, you need to keep some reserves,” Boumpas said.
However, no matter what stage of disease patients present with, it is essential to meet the energy of disease and treat accordingly, he added.
“Another concept in lupus is that the more aggressive the disease, the more aggressive you go,” Boumpas said. “Use the big guns for the bad lupus.”
The goal of all lupus therapies is to achieve the treatment targets, such as allowing as little disease activity as possible, preventing organ damage through preventing flares, improving health-related quality of life scores and, ultimately, ensuring patient survival, according to Boumpas.
“How do you do that? By trying to achieve remission or low disease activity, the prevention of flares, [using] the lowest possible dose of glucocorticoids and using new drugs,” he said.
To reach the desired therapy goals, clinicians should consider input from disease and damage indices measuring the impact of lupus. These should also be used to help measure the impact of therapies on patients, according to Boumpas. At the end of the day, the current models are imperfect and have room to be refined.
“You have to use [indices and disease measures], because otherwise, you don’t know where you’re going,” Boumpas said. “There is still room for their improvement.”
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Boumpas DT. How to treat systemic lupus erythematosus. Presented at: EULAR 2023 Congress; May 31 to June 3, 2023, Milan, Italy.
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