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Lupus Treatment May Soon Take Leap Forward

FRIDAY Dec. 24, 2010 -- For years now, doctors have made slow, incremental progress in the treatment of lupus, a chronic autoimmune condition that can wrack the body and seriously affect a person's health.

But researchers now are preparing for a potential major leap forward.

A new medication that could be an effective new treatment for the disease was endorsed in mid-November by an advisory panel of the U.S. Food and Drug Administration and recommended for approval. Though the FDA is not bound by its advisory committees' recommendations, it usually follows them.

"There is real optimism there may be a drug approved for the treatment of lupus for the first time in 54 years," said Dr. Mary Anne Dooley, an associate professor at the University of North Carolina Kidney Center.

Lupus primarily affects women. Nine out of 10 people who have lupus are women. It also appears to be more common among black, Hispanic, Asian and Native American women than white women.

The disease causes the immune system to begin harming the organs and the systems of the body. "Your immune system becomes hyperactive, and, instead of defending you from infection, it attacks parts of your body," Dooley said.

According to Dooley and the U.S. National Institutes of Health, the most common symptoms of lupus include:

  • A "butterfly" rash across the nose and cheeks.
  • Skin rashes elsewhere.
  • Skin photosensitivity.
  • Joint pains and stiffness.
  • Muscle aches and pain.
  • Hair loss.
  • Fatigue.
  • Fever not linked to any other illness.
  • Anemia.
  • Difficulty concentrating or remembering.

"Lupus primarily attacks the skin and the joints, but any organ can be affected," said Dr. Cynthia Aranow, an associate investigator with the Feinstein Institute for Medical Research at the North Shore-Long Island Jewish Health System in New York.

When the organs are affected, people with lupus can suffer serious health effects. They face an increased risk for kidney damage and other long-term health problems, and "women with lupus are 50 times more likely to develop heart disease than women without lupus," Dooley said.

Researchers have not yet figured out what prompts lupus. Studies suggest that genetics probably play a large role, but there also seems to be another factor that triggers the disease, Aranow said.

"We know it's more than the genes," she said. "If one twin has lupus, the risk of the other twin developing lupus is only 25 to 50 percent."

Improvements in lupus treatment have helped people live longer and healthier lives. In 1950, a person diagnosed with lupus had a 50 percent chance of surviving two years, Aranow said. Today, the 10-year survival rate for someone with lupus very nearly mirrors that of the overall population.

However, the improvements have not come from research specifically targeted to lupus. The last lupus drug to receive approval, Plaquenil, was approved in the 1950s, Dooley said.

Instead, doctors have improved lupus treatment through the use of medications created for other diseases. "Rheumatologists beg, borrow and steal medications from other specialties," Aranow said. These include immunosuppressive drugs and newer anti-malarials, anti-inflammatories and corticosteroids.

But that could change soon with Benlysta (belimumab), which has shown promise as a lupus treatment.

Benlysta works by downregulating the communication between the immune system's T and B cells, Dooley said. The T cells govern the immune response and tell B cells what sort of antibodies to produce.

"It doesn't completely prevent communication, but it reduces the hyperactivity," Dooley said. "You're still able to fight off infection and have your immune system be effective this way, but you wouldn't have all these markers of immune hyperactivity."

Benlysta has been boosted by two major studies that have come out in the past year showing its effectiveness. And, although the FDA had expressed concerns about safety, questioning whether its use might be linked to depression and suicide, the advisory panel examined safety data and decided otherwise.

At the same time, lupus researchers continue to pinch medications and treatments from other specialties. Research is underway to see whether an immunosuppressive drug created to maintain kidney transplants, mycophenolate mofetil (MMF), could be an effective lupus drug. It has become generic and, therefore, less expensive, and it may have fewer side effects than other lupus medications, Dooley said.

"It's important for people [with lupus] to realize that they're not alone, that the outlook is much better and there are all sorts of resources available," Aranow said.

More information

The Lupus Foundation of America has more about lupus.

For more on lupus, read about one woman's story.

Posted: December 2010


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