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Disease-modifying therapies in systemic lupus erythematosus for extrarenal manifestations

Authors :
Munther Khamashta
Richard A Furie
Ian N Bruce
Ronald van Vollenhoven
Murray B Urowitz
Andreas Schwarting
Ming-hui Zhao
Anca D Askanase
Mark Daniels
Andrew S Bomback
Angela Carroll
Bernie Rubin
Roger Abramino Levy
Source :
Lupus Science and Medicine, Vol 11, Iss 1 (2024)
Publication Year :
2024
Publisher :
BMJ Publishing Group, 2024.

Abstract

Our 2022 published working definition of disease modification in systemic lupus erythematosus (SLE) was ‘minimising disease activity with the fewest treatment-associated toxicities and slowing or preventing organ damage progression’. The objective of this review was to classify current SLE treatments according to the proposed non-renal disease modification criteria excluding toxicities. Based on a review of select clinical trial (n=32) and observational study (n=54) publications for 14 SLE medications across different therapeutic classes, and the authors’ clinical experience, we evaluated disease modification potential as per the proposed framework at three time points. Specific criteria used to determine disease modification potential included a drug’s capacity to reduce: (1) non-renal disease activity, (2) severe flares, (3) use of steroids/immunosuppressants and (4) organ damage accrual. Criteria 1–3 were assessed at 1 year and 2–5 years and, when positive, were considered evidence for disease modification potential; criterion 4 was used to confirm disease modification at >5 years. Each treatment received one of four mutually exclusive designations at each time point: (a) criterion met, (b) indications of criterion met despite insufficient evidence in the literature, (c) inconclusive and (d) no available supportive data. This review excludes an assessment of potential toxicities. Eight of the 14 SLE treatments met ≥1 disease modification criteria up to year 5. Hydroxychloroquine improved overall survival at >5 years, suggesting long-term disease modification, but no data on specific organ systems were reported. Belimumab was the only treatment to meet all criteria. Belimumab and hydroxychloroquine met disease modification definitions across three time points. Evidence for other SLE therapies was incomplete, particularly at >5 years. Future studies are warranted for other treatments to meet the disease modification criteria. We discuss challenges to classification and possible updates to our published criteria.

Details

Language :
English
ISSN :
20538790
Volume :
11
Issue :
1
Database :
Directory of Open Access Journals
Journal :
Lupus Science and Medicine
Publication Type :
Academic Journal
Accession number :
edsdoj.3978731451ab4b52af1def567e5d6564
Document Type :
article
Full Text :
https://doi.org/10.1136/lupus-2023-001124