New biomarker could guide treatment for lupus patients

Levels of a particular antibody in the blood could predict how well people with lupus respond to a new treatment approach, according to UCLH and UCL research.

The finding from the BEAT-Lupus clinical trial means that the treatment could be better targeted to patients who are most likely to respond to it, and lead to better patient outcomes.

If results from the trial are confirmed in other trials, then testing for levels of the blood biomarker – an antibody known as IgA2 anti-dsDNA – could be introduced into routine care.

Results from the BEAT-Lupus trial led by UCLH consultant rheumatologist Prof Mike Ehrenstein published last year showed that treating lupus patients with a combination therapy of the drugs belimumab after rituximab is safe and reduces symptoms and flares in patients with systemic lupus erythematosus (SLE) – the most common form of lupus.

For this latest part of the research, published in The Lancet Rheumatology, samples from the trial were analysed and researchers found that patients with high levels of the blood biomarker (IgA2 anti-dsDNA) were much more likely to respond to the combination treatment.

Both drugs are currently recommended to treat patients who are not responding to conventional treatments – though at present the drugs cannot be given together in England as it is believed the combination therapy is not cost effective.

The finding that a biomarker in the blood can predict who will respond to the combination therapy could open up access to the treatment, because targeted use of the drug would improve outcomes among the patients who receive it – making the treatment more cost effective.

There is no cure for lupus at present. The condition can respond well to a number of drugs but these treatments often include steroids, or other drugs, which are associated with numerous side effects including increased susceptibility to infection.

More effective treatments are needed, but the development of new treatments is difficult, and many clinical trials have shown no or only modest benefit for patients. In England, access to some treatments that have shown benefit is limited as it is considered that they are not cost effective.

Professor Ehrenstein said: “We know that combination treatment with rituximab then belimumab can reduce disease activity in lupus. Our latest finding that we could predict who will best respond to this treatment means that we could offer this new treatment in a targeted way – meaning patients who receive the treatment are likely to benefit highly and meaning that the treatment would represent good value for money for the NHS.

“Use of this blood biomarker in routine practice to enable such precision medicine would immensely benefit patients, who are impacted at present by a lack of treatments.”

The BEAT-Lupus trial was funded through a collaboration between Versus Arthritis and GlaxoSmithKline, with additional support from the NIHR UCLH Biomedical Research Centre, the NIHR Musculoskeletal Translational Research Collaboration and Lupus UK. Further funding from Versus Arthritis has been awarded and will help to ensure that the discovery of this biomarker can improve the care of patients with SLE.

 

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