The cruel reality of lupus


Greg Keenan, M.D.

Imagine a complex, incurable, chronic disease with no known cause that can attack nearly every organ system in the body, may take years to diagnose, can result in severe fatigue on a daily basis and can even result in death.

That’s systemic lupus erythematosus (SLE)—also known as lupus. Even crueler is its predisposition toward young women—usually becoming symptomatic sometime between puberty and age 40—who are left with limited options that include a regimen of prescription oral and topical steroids and perhaps chemotherapy to treat the features of the disease. Unfortunately, some of those treatments have very troublesome side effects such as weight gain, hair loss, cataracts, acne and an increased risk of infection, to name a few.

The combination of battling the fluctuating symptoms of an incurable disease with the nasty and quite visible side effects of drugs—which may or may not even offer relief—may take these women out of the social loop. And that, of course, adds yet another discouraging element to an already-frustrating condition. Isolation is never good, but when you’re a young woman in the prime of life, it’s devastating.

Unfortunately, we don’t know enough about lupus yet. There is no lupus blood test, which is why it so often takes several years to diagnose. We don’t know what causes it, though there are clearly genetic and hormonal factors to consider. And, we certainly don’t know how to prevent it, though there are things that patients can do to minimize the risk and intensity of flare-ups.

What we do know is that lupus is an autoimmune disease in which the immune system produces antibodies that, instead of targeting viruses or other foreign invaders, attacks healthy tissue in the body—potentially including skin, joints, the brain, kidneys and blood vessels. The Lupus Foundation of America estimates about 1.5 million Americans have the condition, with 16,000 more reported annually, and that there are approximately 5 million people with some form of lupus worldwide. We know it strikes predominantly young women, and especially African-American women, but men can get it, too. And, when they do, their symptoms are often much more severe.

Here’s what else we know: We have a lot of work to do. Clinicians need a way to offer a definitive diagnosis of lupus sooner and we need medicines that work better, and have a better safety profile. Finally, we need a way to accelerate the ability to identify new treatments and design more effective clinical trials.

Something else we know is that inflammatory signalling in the body by proteins called cytokines plays a role in the pathogenesis of lupus, and that elevated levels of one type of signalling cytokine called interferon-alpha (IFN-α)—correlates with more severe disease activity. This week at the American College of Rheumatology (ACR) 2014 Annual Meeting, we presented data on two investigational human monoclonal antibodies (mAbs)—sifalimumab and anifrolumab—that target interferon-alpha in patients with lupus.

Developing new medicines to treat lupus is challenging; only one new drug has been introduced in the last six decades. But, we’re committed to this effort and are excited about the data on these two molecules. We’re rolling up our sleeves on this and on a mission to gain more knowledge about lupus and improve the lives of those patients who are living with it.