Lupus Treatment Landscape Evolves With Biologics and Emerging Cellular Therapies: Margrit Wiesendanger, MD, PhD

In part 2 of an interview with Margrit Wiesendanger, MD, PhD, of the Icahn School of Medicine at Mount Sinai, she discusses the most commonly used treatments for lupus and how the landscape is evolving with innovations like biologics. She also shares insights into ongoing clinical trials and emerging therapies that may shape the future of lupus care.

Watch part 1 to learn more about the clinical presentation of lupus, diagnostic challenges, and the populations most affected.

This transcript was lightly edited; captions were auto-generated.

Transcript

What are the current standard-of-care treatments for lupus? How have newer therapies, like biologics, changed the treatment landscape?

The mainstay of treatment is hydroxychloroquine. This is an oral medicine that modulates the immune system and has been shown to prevent exacerbations of lupus, so it's an excellent maintenance medicine.

However, when patients are first diagnosed and have severe symptoms, they may need moderate or high dose corticosteroids to rapidly reduce inflammation in internal organs, followed then by a steroid sparing immunosuppressive, something that also modulates the immune system very potently but is not a steroid, such as mycophenolate mofetil, azathioprine, tacrolimus, and voclosporin; these are some examples.

In addition, there are biological therapies based on monoclonal antibodies that have more precise targeting of the immune system. They specifically remove key molecules, cytokines, that drive inflammation. Two approved biologics for the treatment of lupus include belimumab, which targets the B-cell activating factor, and anifrolumab, which targets the type 1 interferon receptor.

These biologic therapies can be combined with, say, mycophenolate to treat kidney disease and protect renal function. Thanks to these new treatments, a condition that could be rapidly fatal 50 years ago is now much more manageable. Patients are living almost normal lifespans. I should also credit the advances in infectious diseases. Better antimicrobials have allowed us to treat infections that are caused by some of the potent immunosuppressants we need to use, and so that's been a great advance in helping people live longer and better lives.

Another one is the recognition that chronic inflammation leads to heart disease over time. We are better able to help our patients who survive the acute lupus, shall we say. Then, help them reach their professional goals and live good lives overall.

Looking ahead, are there any ongoing clinical trials or emerging treatment developments that you're particularly excited about?

While we have made tremendous strides in the diagnosis and treatment of lupus, for too many patients, there has been a seriously negative impact, not just from the autoimmune inflammation itself, but even from the medicines that we have used to help them. There's definitely an unmet need in systemic lupus, and the newest treatments that are being investigated currently are cellular therapies.

These were originally developed to treat hematologic cancers, like lymphoma and multiple myeloma. The concept is that by using live T cells as the actual therapeutic, we can more profoundly stop the aberrant immune system in its tracks, protect the threatened organs, prevent damage, prevent scar tissue from forming in these organs, as compared with the oral and injected molecules we have used until now. This is in phase 1 and 2 clinical trials currently.