New therapies for systemic lupus erythematosus - past imperfect, future tense; Murphy G, Isenberg D; Nature Reviews Rheumatology (Jun 2019)
Tags: belimumab Lupus rituximab
The failure of many new, mostly biologic, drugs to meet their primary end points in double-blind clinical trials in patients with systemic lupus erythematosus (SLE) has caused a profound sense of disappointment among both physicians and patients. Arguably, the success of B cell depletion with rituximab in open-label clinical trials, the approval of belimumab (which blocks B cell-activating factor (BAFF)) for use in patients with lupus nephritis in the USA and in difficult-to-treat patients with SLE in the UK and the recognition that clinical trial design can be improved have given some cause for hope. However, changes to therapies in current use and the development of new approaches are urgently needed. The results of the latest studies investigating the use of several new approaches to treating SLE are discussed in this Review, including: fully humanized anti-CD20 and anti-CD19 monoclonal antibodies; inhibition of tyrosine-protein kinase BTK; CD40 ligand blockade; interfering with the presentation of antigen to autoreactive T cells using a peptide approach; a receptor decoy approach using an analogue of Fcγ receptor IIB; dual blockade of IL-12 and IL-23; and inhibition of Janus kinases.
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I’ve been receiving Rituximab treatment for the last 5 years and it works very well at treating my neurological symptoms when other drugs, such as methotrexate and mycophenalate failed. I’m very surprised at the result of these clinical trials. Then again, everyone is different and Rituximab doesn’t work for every person with severe lupus. Two of my friends were given Rituximab treatments and they had very bad reactions to it, whereas they can tolerate methotrexate and I can’t.
I am relieved to read that Rituximab has worked for you. It also worked for a friend who has rheumatoid arthritis. As you say, we are all different and some drugs can't be tolerated!
Absolutely - there’s no guarantee that a particular drug will work for you unless you try it. I was on azathioprine for 11 years and it worked great for that time. However, one of my friends tried azathioprine and it made her really ill. I’m also on hydroxychloroquine and have been for 17 years. It’s a great drug for me, but when my friend was put on it, it made her hair fall out. So, finding the right drug is so important and for most of us, we just have to keep trying until we find the right one (or two or three!)
Hope you’re doing okay, Ros. Lovely to hear from you and I hope you have a lovely weekend! It’s sunny here, so I’m avoiding it as best I can!
I am also allergic to AZA as a have a defective enzyme which doesn't break it down or excrete it via the kidneys. I was put on AZA because of the terrible sickness with MTX. Fortunately, MTX became available in an injectionable form in the UK, so I reverted back to MTX!
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