Abstract
Purpose of Review
Because of the complexity of systemic lupus erythematosus (SLE), different approaches are undertaken while investigating potential therapeutic compounds to treat the disease. The purpose of this review is to summarize the results from recent clinical trials, which investigated different compounds for treating SLE.
Recent Findings
Targeting B cells and type I interferons constitutes the major focus in recent clinical trials. The potential for therapeutic effects of small molecule inhibition such as JAK, Tyk, and Btk is now being investigated for treating SLE. The immunoregulation of T cell activation in SLE is studied using low-dose IL-2 and CD40 ligand inhibition. There are clinical trials that study bispecific antibodies, with binding specificities for 2 different target molecules related to T- and B-cell activation or to different aspects of B cell activation. An approach of combination treatment is also being studied.
Summary
Clinical trials are underway and new treatment compounds for SLE are being anticipated.
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References
Papers of particular interest, published recently, have been highlighted as: • Of importance
Baker KP, Edwards BM, Main SH, Choi GH, Wager RE, Halpern WG, et al. Generation and characterization of LymphoStat-B, a human monoclonal antibody that antagonizes the bioactivities of B lymphocyte stimulator. Arthritis Rheum. 2003;48(11):3253–65.
van Vollenhoven RF, Navarra SV, Levy RA, Thomas M, Heath A, Lustine T, et al. Long-term safety and limited organ damage in patients with systemic lupus erythematosus treated with belimumab: a phase III study extension. Rheumatology (Oxford). 2020;59(2):281–91.
• Furie R, Rovin BH, Houssiau F, Malvar A, Teng YKO, Contreras G, et al. Two-year, randomized, controlled trial of belimumab in lupus nephritis. N Engl J Med. 2020;383(12):1117–28 This is a trial in patients with lupus nephritis that suggests the advantageous effects of belimumab when co-administrated with the standard of care.
Austin HA III, Boumpas DT, Vaughan EM, Balow JE. Predicting renal outcomes in severe lupus nephritis: contributions of clinical and histologic data. Kidney Int. 1994;45:544–50.
Dall’Era M, Stone D, Levesque V, Cisternas M, Wofsy D. Identification of biomarkers that predict response to treatment of lupus nephritis with mycophenolate mofetil or pulse cyclophosphamide. Arthritis Care Res (Hoboken). 2011;63:351–7.
Touma Z, Urowitz MB, Ibañez D, Gladman DD. Time to recovery from proteinuria in patients with lupus nephritis receiving standard treatment. J Rheumatol. 2014;41:688–97.
Merrill JT, Wallace DJ, Wax S, Kao A, Fraser PA, Chang P, et al. ADDRESS II investigators. Efficacy and safety of atacicept in patients with systemic lupus erythematosus: results of a twenty-four-week, multicenter, randomized, double-blind, placebo-controlled, parallel-arm, phase IIb study. Arthritis Rheumatol. 2018;70(2):266–76.
Morand EF, Isenberg DA, Wallace DJ, Kao AH, Vazquez-Mateo C, Chang P, et al. Attainment of treat-to-target endpoints in SLE patients with high disease activity in the atacicept phase 2b ADDRESS II study. Rheumatology (Oxford). 2020;59(10):2930–8.
Ostendorf L, Burns M, Durek P, Heinz GA, Heinrich F, Garantziotis P, et al. Targeting CD38 with daratumumab in refractory systemic lupus erythematosus. N Engl J Med. 2020;383(12):1149–55 Although daratumumab has not been studied in a clinical trial in patients with SLE, this is a report that exemplifies the beneficial response to the inhibition of long-lived plasma cells.
Liu J, Farmer JD Jr, Lane WS, Friedman J, Weissman I, Schreiber SL. Calcineurin is a common target of cyclophilin-cyclosporin A and FKBP-FK506 complexes. Cell. 1991;66(4):807–15.
Mok CC, Ying KY, Yim CW, Siu YP, Tong KH, To CH, et al. Tacrolimus versus mycophenolate mofetil for induction therapy of lupus nephritis: a randomised controlled trial and long-term follow-up. Ann Rheum Dis. 2016;75(1):30–6.
Mok CC, Ho LY, Ying SKY, Leung MC, To CH, Ng WL. Long-term outcome of a randomised controlled trial comparing tacrolimus with mycophenolate mofetil as induction therapy for active lupus nephritis. Ann Rheum Dis. 2020;79(8):1070–6.
Sharabi A, Tsokos MG, Ding Y, Malek TR, Klatzmann D, Tsokos GC. Regulatory T cells in the treatment of disease. Nat Rev Drug Discov. 2018;17(11):823–44.
• He J, Zhang R, Shao M, Zhao X, Miao M, Chen J, et al. Efficacy and safety of low-dose IL-2 in the treatment of systemic lupus erythematosus: a randomised, double-blind, placebo-controlled trial. Ann Rheum Dis. 2020;79(1):141–9 This is the first randomized clinical trial that demonstrates the immunomodulatory effects of low dose IL-2 in patients with SLE.
Morand EF, Furie R, Tanaka Y, Bruce IN, Askanase AD, Richez C, et al. TULIP-2 trial investigators. Trial of anifrolumab in active systemic lupus erythematosus. N Engl J Med. 2020;382(3):211–21.
Houssiau FA, Thanou A, Mazur M, Ramiterre E, Gomez Mora DA, Misterska-Skora M, et al. IFN-α kinoid in systemic lupus erythematosus: results from a phase IIb, randomised, placebo-controlled study. Ann Rheum Dis. 2020;79(3):347–55.
Furie R, van Vollenhoven R, Kalunian K, Navarra S, Romero-Díaz J, Werth V, et al. Efficacy and safety results from a phase 2, randomized, double-blind trial of BIIB059, an anti-blood dendritic cell antigen 2 antibody, in SLE. Presented at 2020 ACR/ARP annual meeting, abstract# 0935. Arthritis Rheumatol. 2020;72 (suppl 10).
Werth V, Furie R, Romero-Díaz J, Navarra S, Kalunian K, van Vollenhoven R, et al. BIIB059, a humanized monoclonal antibody targeting blood dendritic cell antigen 2 on plasmacytoid dendritic cells, shows dose-related efficacy in a phase 2 study in participants with active cutaneous lupus erythematosus. Presented at 2020 ACR/ARP annual meeting, abstract# 0986. Arthritis Rheumatol. 2020;72 (suppl 10).
van Vollenhoven RF, Hahn BH, Tsokos GC, Lipsky P, Fei K, Gordon RM, et al. Maintenance of efficacy and safety of ustekinumab through one year in a phase II multicenter, prospective, randomized, double-blind, placebo-controlled crossover trial of patients with active systemic lupus erythematosus. Arthritis Rheumatol. 2020;72(5):761–8.
van Vollenhoven R, Hahn B, Tsokos G, Lipsky P, Gordon R, Fei K, et al. Maintenance of efficacy and safety and reduction of BILAG flares with ustekinumab, an interleukin-12/23 inhibitor, in patients with active systemic lupus erythematosus: 2-year results of a phase 2, randomized placebo-controlled, crossover study. Presented at 2020 ACR/ARP annual meeting, abstract# 1826. Arthritis Rheumatol. 2020;72 (suppl 10).
Wallace DJ, Furie RA, Tanaka Y, Kalunian KC, Mosca M, Petri MA, et al. Baricitinib for systemic lupus erythematosus: a double-blind, randomised, placebo-controlled, phase 2 trial. Lancet. 2018;392(10143):222–31.
Wallace D, Dörner T, Pisetsky D, Sanchez-Guerrero F, Kao A, Parsons-Rich D, et al. Efficacy and safety of evobrutinib (M2951) in adult patients with systemic lupus erythematosus who received standard of care therapy: a phase II, randomized, double-blind, placebo-controlled dose ranging study. Presented at 2020 ACR/ARP annual meeting, abstract#0865. Arthritis Rheumatol. 2020;72 (suppl 10).
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Sharabi, A. Updates on Clinical Trials in Systemic Lupus Erythematosus. Curr Rheumatol Rep 23, 57 (2021). https://doi.org/10.1007/s11926-021-01014-w
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DOI: https://doi.org/10.1007/s11926-021-01014-w