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01-07-2021 | Lupus Nephritis | Correspondence

A hypothetical future in rheumatology: will we miss steroids in a steroid free-world?

Author: Sakir Ahmed

Published in: Rheumatology International | Issue 7/2021

Excerpt

The recently published phase III trial of avacopan in ANCA-associated vasculitis has opened up avenues for steroid-free management of small vasculitis [1]. A similar promise is being explored in the context of lupus nephritis [2]. Mulling over a rheumatology world free of steroids, and influenced by a piece on big-data and artificial intelligence-based futuristic diagnostics [3], I envisaged a hypothetical doctor, Timothy, of the future who wonders how the steroid era would have been. …

Jayne DRW, Merkel PA, Schall TJ, Bekker P (2021) Avacopan for the treatment of ANCA-associated vasculitis. N Engl J Med 384:599–609. https://doi.org/10.1056/NEJMoa2023386CrossRefPubMed

Condon MB, Ashby D, Pepper RJ et al (2013) Prospective observational single-centre cohort study to evaluate the effectiveness of treating lupus nephritis with rituximab and mycophenolate mofetil but no oral steroids. Ann Rheum Dis 72:1280–1286. https://doi.org/10.1136/annrheumdis-2012-202844CrossRefPubMed

Burmester GR (2018) Rheumatology 4.0: big data, wearables and diagnosis by computer. Ann Rheum Dis 77:963–965. https://doi.org/10.1136/annrheumdis-2017-212888CrossRefPubMedPubMedCentral

Orange DE, Yao V, Sawicka K et al (2020) RNA identification of PRIME cells predicting rheumatoid arthritis flares. N Engl J Med 383:218–228. https://doi.org/10.1056/NEJMoa2004114CrossRefPubMedPubMedCentral

Kansal R, Richardson N, Neeli I et al (2019) Sustained B cell depletion by CD19-targeted CAR T cells is a highly effective treatment for murine lupus. Sci Transl Med 11:eaav1648. https://doi.org/10.1126/scitranslmed.aav1648CrossRefPubMed

Ahmed S (2019) CAR T-cells to drive away autoimmunity in lupus. Indian J Rheumatol 14:177–179. https://doi.org/10.4103/injr.injr_118_19CrossRef

Trouw LA, Pickering MC, Blom AM (2017) The complement system as a potential therapeutic target in rheumatic disease. Nat Rev Rheumatol 13:538–547. https://doi.org/10.1038/nrrheum.2017.125CrossRefPubMed

Alexander T, Sarfert R, Klotsche J et al (2015) The proteasome inhibitior bortezomib depletes plasma cells and ameliorates clinical manifestations of refractory systemic lupus erythematosus. Ann Rheum Dis 74:1474–1478. https://doi.org/10.1136/annrheumdis-2014-206016CrossRefPubMedPubMedCentral

Chasset F, Arnaud L (2018) Targeting interferons and their pathways in systemic lupus erythematosus. Autoimmun Rev 17:44–52. https://doi.org/10.1016/j.autrev.2017.11.009CrossRefPubMed

10.

Miteva LD, Manolova IM, Ivanova MG et al (2020) High interleukin-18 and low FOXP3 mRNAs in peripheral blood of women with severe systemic lupus erythematosus: a cross-sectional study. Rheumatol Int 40:727–735. https://doi.org/10.1007/s00296-020-04542-3CrossRefPubMed

11.

Furie R, Rovin BH, Houssiau F et al (2020) Two-year, randomized, controlled trial of belimumab in lupus nephritis. N Engl J Med 383:1117–1128. https://doi.org/10.1056/NEJMoa2001180CrossRefPubMed

Title: A hypothetical future in rheumatology: will we miss steroids in a steroid free-world?
Author: Sakir Ahmed
Publication date: 01-07-2021
Publisher: Springer Berlin Heidelberg
Keywords: Lupus Nephritis
Targeted Therapy
Published in: Rheumatology International / Issue 7/2021
Print ISSN: 0172-8172
Electronic ISSN: 1437-160X
DOI: https://doi.org/10.1007/s00296-021-04884-6

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