Lupus is often talked about as an illness of mystery, but our knowledge of it has grown tremendously in recent years. The laboratory research done at HSS and other institutions is helping to explain the basic biology of lupus, while clinical trials and other forms of clinical research continue to enhance our approach to patient care. Here, leading lupus experts Mary K. Crow, MD, and Jane Salmon, MD, identify some of the top lupus research breakthroughs from 2019.
- Progress toward a second approved drug for lupus: In December, an international team of clinical researchers published the results of a phase III clinical trial demonstrating the efficacy of the drug anifrolumab in lupus patients. If approved, it would be only the second drug approved for lupus by the US Food and Drug Administration, after belimumab. Unlike belimumab, anifrolumab works by blocking receptors for the protein type I interferon. [Dr. Crow and others previously have demonstrated that type I interferon is overproduced in lupus.] The results also make a case for allowing greater flexibility in lupus clinical trial design, which could pave the way for more therapeutic options.
- Confirmation that women with lupus can have safe pregnancies: HSS rheumatologist Bella Mehta, MD, published work demonstrating dramatic improvements in pregnancy outcomes among women with lupus. Dr. Mehta reviewed patient data from 1998 to 2015 to look for trends and complications, and reported a significantly lower rate of maternal death as well as a lower rate of complications such as preeclampsia. Advances in diagnosis and treatment have improved outcomes for lupus patients in recent years, but until now, no data existed to show that those improvements extended to women wishing to become pregnant. [Dr. Salmon is currently leading a trial of the first biologic therapy to prevent pregnancy complications in women at high risk.]
- An epigentic approach to lupus treatment: Researchers at HSS, including Chief Scientific Officer Lionel Ivashkiv, MD, published work suggesting the importance of environmental factors in the function of cells involved in lupus. Such research could sow the seeds for a new class of epigenetic drugs able to reprogram the cells involved in lupus to help them become normal functioning cells. Likely, such work would focus on reducing organ damage in people with lupus. We also believe that epigenetic drugs could offer more durable responses than those produced by belimumab.
- Taking aim at the cells that produce interferon: HSS scientist Franck Barrat, PhD, and colleagues showed that significantly better treatment outcomes are possible in mouse models of lupus and scleroderma when plasmacytoid dendritic cells, or PDCs, are inhibited. Previous work led by Dr. Barrat’s lab demonstrated that PDCs produce large amounts of interferon. Clinical trials of drugs that target PDCs are currently under way in people with lupus.
Dr. Mary K. Crow is Physician-in-Chief and Chair of the Department of Medicine at HSS. She is also the Director of the Autoimmunity and Inflammation Research Program and Co-Director of the Mary Kirkland Center for Lupus Research at HSS. Dr. Crow’s academic and research career has focused on unraveling the cellular and molecular mechanisms that underlie the systemic autoimmune diseases, with a particular focus on systemic lupus erythematosus and rheumatoid arthritis.
Dr. Jane Salmon is Co-Director of the Mary Kirkland Center for Lupus Research, Director of the SLE APS Center of Excellence, Director of the FOCIS Center of Excellence, and Director of the Lupus Registry and Repository. Dr. Salmon’s research has focused on elucidating mechanisms of tissue injury in lupus and other autoimmune diseases. Her basic and clinical studies have expanded our understanding of pregnancy loss and organ damage in SLE and the determinants of disease outcome in lupus patients with nephritis, pregnancy, and cardiovascular disease.