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Highlights of the American College of Rheumatology 2009 Annual Scientific Meeting

ACR Special Report: Philadelphia, PA, October 18-21, 2009

Highlights of the American College of Rheumatology
2009 Scientific Meeting

The highlight of the 2009 American College of Rheumatology (ACR) Annual Scientific Meeting in Philadelphia in late October was the positive results reported in two studies of the investigational drug, belimumab (Benlysta™). These findings were balanced, however, against more disappointing results from a pivotal clinical trial with rituximab (Rituxan®) that showed again that the drug provided no additional benefit to standard therapy in the population studied.

How could two drugs that have similar effects in the body have such different results? Alliance for Lupus Research (ALR) Scientific Advisory Board Chair Mary (Peggy) K. Crow, MD, thinks it may be related to the way the studies were designed.

"We have to look very carefully at the clinical trial data to determine why the rituximab studies did not meet its endpoints and the belimumab studies showed positive results," she said. "What does this tell us about either clinical trial design or the mechanism of action of these two agents in the context of lupus? For instance, what did we learn about the role of B cell differentiation in the pathogenesis of lupus through these clinical trials? The answers will illuminate new directions for research."

Dr. Crow was also struck by the number of studies presented on cardiovascular disease and pregnancy in lupus, both of which are covered in this report.

Dr. Crow attended the pre-conference meeting on basic science issues in lupus, primarily the genetics of the disease. "I think there has been continued progress since the publication of the ALR-funded International SLE Genetics Consortium (SLEGEN) that identifies additional genes that are gaining the statistical support needed to identify them with lupus," she said. "However, there is growing agreement that investigators need to move to the next step and understand the functional implications of the genetic associations with the disease. In other words, exactly what do the associated genes do that contributes to lupus."

Dr. Crow said she was intrigued by the potential of subphenotyping (i.e., identifying patients based on specific immunologic signatures, such as anti-DNA antibodies or interferon levels, and then linking those subtypes to specific genetic signatures).

"We've recognized that lupus is a very heterogenous disease, but it is becoming clear from the data now that there are specific populations of patients," Dr. Crow said. "This is particularly important when designing clinical studies to assess specific treatments. Some treatments may only be effective in patients with certain genetic profiles, a finding that is often difficult to obtain when all patients are simply classified as "lupus." In other words, identifying different types of lupus may improve clinical trial results since many treatments appear to work differently in different patients.

Current Needs in Autoimmune Disease

Alliance for Lupus Research Scientific Advisory Board Chair Mary K. Crow, MD, delivered a major talk on progress into autoimmune diseases during the 2009 ACR meeting. While admitting that recent advances in drug development for rheumatic diseases make the area "one of the most interesting" in medicine, challenges remain, particularly in lupus, sclerodermaand other areas. Specifically, she said, the field needs:

  • A greater understanding of the underlying mechanisms of disease to guide the development of more effective therapies.
  • To extrapolate information from studies of established therapies and use that information to guide the development of new drugs.
  • Biomarkers and genetic fingerprints to help clinicians predict disease activity and determine when interventions are needed.
  • Ways to balance control of disease with the toxicity of the intervention.

More information about lupus and treatment advances can be found by visiting www.lupusresearch.org.

The 2009 American College of Rheumatology Meeting Special Report was made possible in part by generous support from Biogen Idec, Genentech and Johnson & Johnson.

Genentech Biogen IdecJohnson & Johnson

©2009 Alliance for Lupus Research. All Rights Reserved.

Contents herein may not be reproduced, republished or distributed without the prior written permission of the Alliance for Lupus Research. To request permission to reproduce, republish or distribute any part of this report, contact us at 212-218-2840 or email info@lupusresearch.org.

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