What Is New - Systemic Lupus Erythematosus (SLE)

Take a look at our 'What is new' highlights in systemic lupus erythematosus (SLE)!

December 2022

"Weaning of maintenance immunosuppressive therapy in lupus nephritis (WIN-Lupus): results of a multicentre randomised controlled trial"

Why WINS?

Proliferative lupus nephritis (LN) can lead to renal failure. In patients with LN, after the induction phase of immunosuppressive therapy (IST), maintenance IST aims to prevent LN relapses. The optimal duration of maintenance IST remains unknown. While current 2019 EULAR/ERA–EDTA recommendations and 2021 KDIGO guidelines are largely based on experts opinion, WIN-Lupus is the first randomised controlled trial testing different durations of IST in proliferative LN. Non-inferiority of maintenance IST discontinuation after 2‒3 years was not demonstrated and patients who discontinued IST had a higher risk of severe flares of lupus. However, the majority of patients who discontinued IST did not experience a flare. Results from the WIN-Lupus study add a significant knowledge regarding the role of histological reassessment in identifying patients who can be safely weaned off maintenance IST.

Interactive question

What are the challenges of identifying patients who can be safely weaned from IST?

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November 2022

" Belimumab use during pregnancy: a summary of birth defects and pregnancy loss from belimumab clinical trials, a pregnancy registry and postmarketing reports "

Why WINS?

The data on the use of belimumab in pregnancy and any associated risk of birth defects and pregnancy loss is very limited. This study provides information about birth defects and pregnancy losses among women exposed to belimumab during pregnancy. Overall, among pregnancies ending in live birth, the numbers of birth defects in belimumab exposed pregnancies were 5.6% in clinical trials, 21.7%, ad hoc 95% CI 9.8% to 33.7% and 0% in the BPR prospective and retrospective cohorts, respectively , and 1.1% in the postmarketing/spontaneous reports, with no consistent pattern of malformations. The numbers of pregnancy losses 31.8% in clinical trials, 4.2%, ad hoc 95%CI 0.0 to 9.8% and 50.0% in the BPR prospective and retrospective cohorts, respectively, and 31.4% in the postmarketing/spontaneous reports.

Interactive question

Do you have any cases of exposure to belimumab during pregnancy?

yes / no

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October 2022

" Anti-CD19 CAR T cell therapy for refractory systemic lupus erythematosus "

Why WINS?

This study evaluates the efficacy of anti-CD19 compassionate-use chimeric antigen receptor (CAR) T cell therapy in 5 patients with SLE refractory to several immunosuppressive drugs with a median SLEDAI of 16. CAR T cells led to improvement of clinical symptoms and laboratory parameters including seroconversion of anti-double-stranded DNA antibodies. All 5 patients achieved remission of SLE according to DORIS criteria after 3 months and the median SLEDAI score after 3 months was 0. Drug-free remission was maintained during longer follow-up median of 8 months after CAR T cell administration. These data suggest that CD19 CAR T cell transfer is highly effective in SLE and provides new therapeutic possibilities to control SLE disease activity using autologous cells however,.

Interactive question

Do you think anti-CD19 CAR-T cell therapy will be a game-changing treatment for SLE patients?

yes / no

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Sep 2022

"Interleukin-13 Receptor α1-Mediated Signaling Regulates Age-Associated/Autoimmune B Cell Expansion and Lupus Pathogenesis"

Why WINS?

IL-13 receptor α1 (IL-13Rα1) which is an X-linked receptor that transmits IL-4/IL-13 signals, is seemed affecting regulation of Age-associated/autoimmune B cells (ABCs) through interleukin-21 (IL- 21) signaling and its interplay with interferon-γ and IL-4. Human research may be conducted on this pathway to investigate sex differeneces in SLE and the data can translate into a potential target for new drug discoveries in the future.

Interactive question

Can IL-13Rα1 and related signaling pathway be one of the factors to explain sex differences in SLE? Furthermore, can it be a potential target for SLE through ABCs?

yes / no

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"Changes on chest HRCT in systemic sclerosis-related interstitial lung disease after autologous hematopoietic stem cell transplantation"

Why WINS?

This study evaluates chest HRCT, lung function and skin score in SSc patients after haematopoietic stem cell transplantation (aHSCT), showing a significant improvement in extent of ILD 24 months after aHSCT, whilst esophageal dilatation and volume worsened. 78% of SSc patients reached radiological response 24 months after aHSCT. This study offers real-world data about the use of aHSCT in early SSc.

Interactive question

What is your experience with haematopoietic stem cell transplantation in systemic sclerosis?

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May 2022

"Proteogenomic analysis of the autoreactive B cell repertoire in blood and tissues of patients with Sjögren's syndrome"

Why WINS?

This omic data illuminated affinity maturation related ANA and RF repertoires findings for the molecular mechanisms of autoreactivity, lymphomagenesis and rituximab response in SjS.

Interactive question

Are novel potential biomarkers derived from this proteomic data promising to be introduced in routine clinical practice for prediction of lymphomagenesis in SjS patients?

Agree / Disagree

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"Impact of Distinct Therapies on Antibody Response to SARS-CoV-2 Vaccine in Systemic Lupus Erythematosus"

Why WINS?

The impact of immunosuppressive drugs on immunogenicity of SARS-CoV-2 vaccine has been one of the main concerns in the management of SLE patients during the pandemic. In this study, the analysis of individual drug effect showed improved seroconversion in HCQ monotherapy, while MMF and prednisone were associated with a lower vaccine response in SLE patients compared to controls.

Interactive question

Have you considered temporary withdrawal of MMF prior to SARS-CoV-2 vaccine in SLE patients?

yes/no

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