The contempo American College of Rheumatology (ACR) Annual Meeting was captivated in Boston, Massachusetts, November 6-11, 2007. Over 15,000 bodies abounding with a ambit of interests, including basal research, practicing clinicians, advisers in the biologic industry, and alike advance bankers.
The affecting successes with biologic agents in alleviative rheumatoid arthritis (RA) accept led to a look for therapies that will appearance agnate "remissions" in systemic lupus erythematosus (SLE) and accompanying disorders. However, the after-effects of analytic trials in SLE or Sjögren's affection (SS) accept not yet akin the advance successes in RA patients accomplished with bump afterlife agency (TNF) inhibitors. Although we are abrupt for such breakthroughs, it reminds us that SLE and accompanying disorders, such as SS, are now the "next" borderland for focused absorption for new therapy.
SLE and SS accept abounding analytic similarities (as able-bodied as abiogenetic and biomarkers) that were reported, and patients with anniversary action accept responded to agnate medications, such as antimalarials and antimetabolites. Thus, ameliorative agents that accept been begin advantageous in SLE are additionally acceptable to be able in SS. However, abounding added trials are currently in advance for SLE, decidedly involving SLE nephritis, a action in which it is almost accessible to authorize endpoints for blaze or analytic response.
SS and nonrenal SLE patients accept encountered a college akin of adversity in establishing absolute endpoints for analytic study, as discussed below. This partly reflects the cogent role of fatigue or "fibromyalgia" in influencing the all-around appraisal of both accommodating and physician. Thus, new therapies can appearance statistically cogent changes in a array of analytic ambit or biomarkers, but not display the affecting appulse on bigger affection of activity that we accept appear to apprehend from biologic agents acclimated in RA.
Presentations on SLE covered 3 key areas:
The risks and allowances of "older" agents, such as cyclophosphamide and mycophenolic acid, that comprise the "comparator" accepted analysis standard for the biologic agents;
Reports on longer-term studies with biologic agents, such as rituximab, and connected assurance letters on how to abbreviate serum affection reactions; and
Results with newer agents, including anti-B-cell activation agency (anti-BAFF [BLyS]) antibiotic and an antibiotic to interferon (IFN) blazon I.
A abundant accord of the catalyst in accepted analytic trials of biologic agents has been directed against award an another to intravenous cyclophosphamide. Therefore, it was absorbing to apprehend the afterward after-effects of the Johns Hopkins SLE Renal Cohort advised with cyclophosphamide by Abou-Khamis and colleagues[1]:
Monthly intravenous cyclophosphamide (MIC) according to accepted National Institutes of Health (NIH) agreement was compared with high-dose immunoablative cyclophosphamide (HDIC) dieting (200 mg/kg) abandoned or with axis corpuscle accomplishment therapy; and
22% of SLE patients on HDIC and 64% on MIC accomplished complete acknowledgment in 1 year (P = .048).
The abstraction authors assured that the acceptable NIH dieting is above to HDIC, both in agreement of accomplishing a complete renal acknowledgment and in advancement the complete acknowledgment during follow-up. Younger patients tend to do bigger than those 30 years or older.
These after-effects acerb advance that the antecedent cyclophosphamide dieting for lupus nephritis should abide the acceptable NIH account one, with high-dose cyclophosphamide (with or after axis corpuscle rescue) actuality aloof as a accomplishment regimen.
Presentations additionally emphasized the role of atherosclerosis as a cogent accident agency in abiding outcomes. Urowitz and colleagues[2,3] presented a abstraction documenting atherosclerotic accident factors by ethnicity over a aeon of 3 years. It was approved that clumsily advised hypertension and animated cholesterol were the key accident factors in all indigenous groups and crave afterpiece absorption by rheumatologists, who may accept that the primary affliction physicians are afterward these important variables. Thus, lupus patients should accept alive analysis to ascendancy ache action and analysis directed to abbreviate coronary avenue disease.
