Experts forecast future of lupus diagnosis and treatment

[Guest guest]

May 19, 2004

Experts forecast future of lupus diagnosis and treatment

New York, NY - Over the next 10 to 20 years, lupus experts a hope to see

advances in both the diagnosis and treatment of systemic lupus erythematosus

(SLE), and some even talk of a cure, according to predictions highlighted

here at the 7th International Congress on Systemic Lupus Erythematosus and

Related Conditions [1].

Gazing into his crystal ball, Dr Jean- Piette (Hôpital

Pitié-Salpêtrière, Paris, France) says that he hopes that the future of SLE

will brings better use of currently available drugsspecifically,

hydroxychloroquine (HCQ).

HCQ is " really a potent drug in lupus and should be used for many years, " he

says, " so why are so few patients on it, and why is HCQ frequently stopped

after 1 to 3 years? " he asks.

It may even have a role in pregnant SLE patients, he says. In the past, " HCQ

during pregnancy was regarded as prohibitive, but times are changing, " he

says. In fact, studies show that it improves pregnancy outcome and seems

safe for the fetus. " There is growing evidence that it poses no risk for the

fetus, " he says. " However, more long-term studies are needed. "

Another issue that needs to be addressed is the unregulated information that

SLE patients may access via the internet or other information sources,

Piette says.

" Patients who go to the web can find much diverse information about disease.

.. . . Some is false, and some isn't true anymore, " he says. Physicians need

to make sure that patients have reliable, up-to-date information about their

disease, he says.

Importantly, physicians " need to give patients recent data about survival "

to eliminate misunderstandings or unfounded optimism.

A further topic that needs more attention is sunscreen and photosensitivity,

Piette says. " The goal of sunscreen is not only to protect skin but also to

avoid the deleterious effect of sun exposure on global disease activity, " he

states.

SLE patients should use a sunscreen with a sun protection factor (SPF) of

more than 50 throughout the yearnot just during summerand everywhere that is

exposed to sunnot only on the face. Sunscreen needs to be applied more than

once a day, he says.

" Worthy and attainable " goals

Weighing in on the future of SLE, Dr Bevra Hahn (University of California,

Los Angeles School of Medicine) says that identifying people at risk of SLE,

suppressing autoantibody production, and preventing damage by autoantibodies

in SLE are worthy and attainable goals.

" I think we should be looking 10 years from now to do these 3 things, " she

says.

In terns of identifying at-risk individuals, Hahn suggests screening women

under 35 for the presence of antinuclear antibodies (ANA) every 3 years and

then following those who test positive for significant ANA with further

screening. From there, doctors may decide on preventive therapies. In

addition, " doctors can watch for the appearance of new autoantibodies, alter

the sex hormone profile, and treat early with safe therapies, " Hahn says.

About 20% of people are positive for antiphospholipid antibodies about 3

years before SLE begins, she says, so the question becomes: " Can you

prevent syndrome? " In this regard, the peptide CD154C may identify

patients at high risk of clotting, she adds.

Hahn would like to see " a boss cytokine " for SLE, similar to the way in

which " TNF is the boss cytokine for rheumatoid arthritis [RA]. " She

speculates that interferon alpha may be that leading cytokine, and if that's

the case, anti-interferon agents may be helpful.

Other cytokines that may be targets in lupus include interferon-gamma (which

is high in SLE and activates B cells) and interleukin-10 (IL-10), which is

also raised in SLE and is involved in B-cell maturation and autoantibody

formation, Hahn says.

Dr Yehuda Schoenfeld (Sheba Medical Center Tel-Hashomer, Israel) largely

agrees with Hahn on the future of SLE. In terms of SLE etiology, he says

that researchers need to " better understand the etiology and harness it

toward the betterment of the patient, " he says.

" By the year 2020, I believe we will be able to prevent the disease, and we

will be able to cure SLE. "

By the year 2020, Schoenfeld hopes that research solves the question of

viral-infection involvement with SLE, including the role played by Epstein

Barr virus (EBV), which is strongly associated with lupus. " If we can find

subjects at risk, maybe we can vaccinate against EBV, " he suggests.

Another goal, he says, is to " better understand the role of apoptosis in

autoimmunity and SLE and improve the clearance of apoptotic cells, " he says.

Genetic information, too, will become important, he predicts. " In 2020, when

we diagnose a patient with SLE, we may be able to predict what type of

systemic involvement that they will have by their genes. "

Treatmentwise, Schoenfeld says, " the future belongs to peptides. " Describing

them as " innocent molecules without side effects, " he says, " we have to

learn better how to employ them. " In addition, he foresees new biologics

emerging over the next 10 years, and so " by 2020, we will pick the best one

for SLE or use a combination as has happened in RA. "

The future for lupus is bright, Schoenfeld believes: " By the year 2020, I

believe we will be able to prevent the disease, and we will be able to cure

SLE. "

Mann

Source

1. Hahn B, Shoenfeld Y, Piette JC, Schur P. Presentation: Various. New York,

NY: 7th International Congress on Systemic Lupus Erythematosus and Related

Conditions: Session on future of SLE; May 9-13, 2004:NA.