Systemic lupus erythematosus (SLE), the most common form of lupus, is associated with a wide range of symptoms and is one of the leading causes of death in young women. Thankfully there has been much progress made in its treatment over recent years. In particular, the introduction of corticosteroids and immune suppressive therapy have played key roles in drastically reducing mortality due to active SLE.

Of note, important efforts have been made toward the development of biologic therapies that are manufactured using living microorganisms, plants, or animal cells. These are being used to treat unmanageable cases of SLE. Anifrolumab, a biologic launched in 2021 used to treat moderate to severe SLE, has been demonstrated to decrease pain and skin manifestations. Since its approval, a study conducted at Brigham and Women’s Hospital in Boston showed one patient was able to reduce their daily Prednisone dose from ten mg to two mg within six months. This is significant considering Prednisone, the most commonly prescribed steroid for lupus, is associated with many side effects. Following Anifrolumab, Litifilimab, a different investigational biologic agent, was approved by the FDA in 2022. In a clinical trial, Litifilimab was also associated with improvements of both skin and joint manifestations of lupus.

A better understanding of the immunopathological mechanisms underlying SLE has allowed researchers to develop biologic agents targeting the dysfunction in the immune system during disease processes. These include, but are not limited to, biologic agents that inactivate or destroy B cells, inhibit the B-cell activating factor (BAFF), inhibit T-cell activation, interfere with T-cell functions, or decrease the production of interferon alpha (IFN-α). T and B cells as well as IFN-α create antibodies used by the body to fight infection.

Along these lines, CART-T therapy, which harnesses a person’s own immune system to fight disease, is a promising approach for the treatment of severe illness. Until now, and most notably, CAR-T has been used to treat various cancers. The approach is now being looked at for treatment of SLE. In a study conducted by the University of Erlangen-Nuremberg, after three months from the first dose of CAR-T, all patients in the trial achieved remission and remained in remission for twelve months -- without the need for other medications. This therapy also caused limited adverse effects with no patient having nervous system issues or infections. Since healthcare providers were able to apply this therapy to SLE, it is likely that in the future it could aid in the treatment of other autoimmune conditions, such as multiple sclerosis.

Historically, lupus treatment has lagged behind other rheumatic disease in terms of breakthrough discovery, though that landscape is finally starting to change for the five million people around the world affected by the condition.  Want to stay informed about opportunities to participate in research studies?  

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References

• Mixed Results for Novel Lupus Drug in Mid-Stage Trial | MedPage Today

• Systemic Lupus Erythematosus (SLE) | CDC

• New Lupus Drug Cuts Skin Disease When Other Agents Fail | MedPage Today

• ‘Huge surprise’: CAR-T cell therapy leads to remission in severe lupus (healio.com)

• Progress toward Better Treatment of Lupus | NEJM

• Mixed Results for Novel Lupus Drug in Mid-Stage Trial | MedPage Today