Lupus Treatment: How Personal Can We Get?

Personalized medicine is all the rage these days, and this caught on during the presentation of novel and current therapies for lupus Monday afternoon. When an exploratory analysis of the Phase 2b MUSE study for anifroliumab on cutaneous and arthritis manifestations of lupus was presented by Joan Merrill this afternoon, it became apparent that the Type 1 interferon signature played a significant role in who responded better. Essentially, patients with higher baseline interferon signatures had greater improvements in lupus skin rash and arthritis at day 365, compared to those with lower baseline signatures.

Similarly, a study on adherence to hydroxychloroquine (HCQ) (Abstract #2010) from France evaluated 305 SLE patients from 19 centres in 10 countries. They assessed adherence to HCQ by measuring blood concentrations of HCQ and its metabolite, desethyl chloroquine (DCQ), and with concomitant administration of adherence questionnaires. Not surprisingly, both patients and physicians were less accurate or forthcoming in reporting lack of adherence compared to the use of the blood levels. Given the significant benefits of HCQ in the treatment and reduction of disease flares in lupus, this may offer a new way to objectively evaluate adherence.

Evidence is mounting that tests such as the Type 1 interferon signature or HCQ/DCQ level can increase our chances for successful management of our complex lupus patients. Such tests may help personalize decision-making for the patient, and assist the physician in better understanding what is actually going on – i.e. is the patient really taking this medication? The economics are important too – even if the test has a cost, it may ensure that higher priced medications are used with the greatest chance of success, and that cheaper medications have truly been utilized to the maximum of their capacity.

More reports from ACR 2016