This year’s ACR Convergence 2021 (ACR21), the world’s premier annual rheumatology meeting of the American College of Rheumatology, offered an exciting flurry of cutting-edge lupus research discoveries, from treatment news to disease management updates. Lupus experts from around the globe, including health care professionals, drug developers, and patient advocates convened from November 3 – 9 to share and discuss the latest findings in lupus research.
Several studies funded by the Lupus Foundation of America (LFA) were presented at the meeting, and our Inside Lupus Research team covered the conference. Read on for this year’s research highlights.
Encouraging advancements on several new and investigational drugs were shared at the meeting:
BIIB059 – Phase 2 study results revealed more promising news for this antibody treatment. The drug was associated with improved joint use in those with lupus-related arthritis. Nearly half (48.2%) of trial participants using the drug saw positive joint response over those taking the placebo treatment.
Iberdomide – A phase 2b study found the drug to be safe and well-tolerated in people with systemic lupus erythematosus (SLE), with sustained clinical benefits up to week 52 of use.
This year’s annual Great Debate at ACR21 centered around potential first-line treatments for lupus nephritis (LN, lupus-related kidney disease): belimumab (Benlysta®) versus voclosporin (Lupkynis™). The question of which treatment to add first to standard therapy was a contested topic of discussion, with strong clinical evidence supporting the safety and effectiveness of both drugs. Ultimately, the debating researchers concluded there is use for both therapies in managing the diverse patient population living with LN.
In other important treatment news, low doses of hydroxychloroquine used to reduce lupus disease activity and flares were associated with increased risk of flares in a new study. Balancing the drug’s benefits with the risk of toxicity at higher doses is challenging but essential in order to discover optimal dosage.
Another study found that 10% of people with lupus were long-term users of opioids compared to just 1% of the comparison group. Long-term opioid use is rarely indicated for the management of chronic pain, due to a lack of effectiveness and risk for developing drug dependency and co-occurring medical problems. Risk factors for long-term opioid use were the duration of lupus disease and having a co-occurring mood disorder or fibromyalgia. Identifying alternative pain management therapies will continue to be a priority in lupus treatment research and patient care.
Looking ahead to future drug research, data presented at ACR21 suggests that the COVID-19 pandemic opened opportunities for the benefits of using telemedicine (TM) in clinical care. According to new survey data shared, the vast majority (more than 75%) of people with lupus report satisfaction with TM, and nearly all (92%) believe their physicians can address their concerns via TM. Meanwhile, clinical trials during the COVID-19 pandemic experienced significant delays with only 39% of trials able to continue as intended. Further data suggest that the future will require more adaptable clinical trial designs that are flexible to individual needs in order to enhance drug response rate and participant retention.
Continue to follow the LFA for the latest lupus treatment discoveries.
At the LFA, everything we do is focused on improving the quality of life for all people affected by lupus, including through awareness, education, care services, and research efforts led and supported by our organization. For ACR21, we shared important program evaluation findings on SELF (Strategies to Embrace Living with Lupus Fearlessly), a new online program developed under a cooperative agreement with the U.S. Centers for Disease Control and Prevention, that’s designed to offer personalized support for lupus warriors looking to build their arsenal of self-management skills.
Our abstract presented at ACR21 assessed SELF’s performance in a program evaluation pilot and revealed key barriers to enrollment and retention that have since led to strategic program changes aimed at improving the sign-up and onboarding process. Findings from the SELF program evaluation also underscored the importance of developing and disseminating effective self-management education – only 1 in 5 program participants at baseline had mastered the majority of skills needed to manage lupus. The updated SELF program will be launched and made widely available in early 2022.
Additionally, Dr. Jane Salmon, Collette Kean Research Professor at Hospital for Special Surgery, presented results of LFA-funded research to develop an algorithm to predict adverse pregnancy outcomes (APO) in high-risk pregnancies in patients with antiphospholipid syndrome (APS). Her study explored the performance of novel and increasingly popular machine learning (ML) approaches for predicting APO, which affects nearly 20% of pregnancies in women with lupus.
And, lead investigator, Dr. Gary S. Gilkeson of the Medical University of South Carolina (MUSC) presented two abstracts on findings from an LFA-funded Phase II Mesenchymal Stromal Cell (MSC) trial. His findings suggest that the use of MSCs in the treatment of lupus presents minimal safety concerns. His research also shows that there is a significant amount of variation in subtypes of immune-system cells known as B-cells within the stromal cells of ethnically and geographically diverse subjects with refractory lupus (lupus that is resistant to treatment). Further studies in this area could reveal a connection between specific B-cell subtypes and distinct forms of lupus or help predict individuals’ responses to treatment based on their personal B-cell profile.
Finally, through the LFA’s partnership with the Childhood Arthritis and Rheumatology Research Alliance (CARRA), we helped fund a study to better understand the practices and preferences of North American pediatricians treating children with LN. The study revealed that, while they’re generally prescribing lower doses of the immunosuppressive drug cyclophosphamide than they were a decade ago, many physicians remain largely unfamiliar with the European protocol, which recommends lower doses of the drug compared to the high-dose cyclophosphamide protocol from the National Institutes of Health (NIH).
Scientific evidence continues to reveal striking health disparities within the lupus community. New data presented at the meeting show that Black and Hispanic lupus warriors have more severe COVID-19 outcomes, such as hospitalization, need for mechanical ventilation, and death, compared to other races and ethnicities.
And, two new studies suggest that, while lupus care and outcomes may be improving overall, disparities along racial and ethnic lines still persist. First, research presented by Joyce C. Chang, MD, a 2018 LFA Gary S. Gilkeson Career Development Award winner, showed that hospitalized Black children with lupus are significantly more likely to experience kidney failure, or require dialysis or kidney transplant than hospitalized white children with lupus, despite the fact that these serious outcomes have decreased overall since 2006.
Furthermore, new research shows that while the rate of hospitalizations for lupus flares has declined over the last 20 years overall, a disproportionate number of those hospitalized are Black. The latest findings urgently highlight the need for more strategically targeted efforts to improve access to care, treatment, and disease management education in these communities.
The Lupus Foundation of America is proud to be a part of the collective, global fight against lupus, developing tools and resources to help today’s lupus warriors overcome the challenges they face – from managing the disease to addressing healthcare disparities – while working to find new treatments and ultimately a cure. Continue to follow Inside Lupus Research for breaking news and important updates and see you at #ACR22!