We stand at the threshold of great progress for lupus. More than 30 qualified pharmaceutical or biotechnology companies are poised to develop treatments specifically for lupus, each finely targeted to provide nuanced regulation of the immue system in ways that ought to have great impact on the disease. However the patients are heterogeneous both clinically and biologically and it must be accepted that one drug, one dose, one method will not fit all. With an increasingly sophisticated understanding of immune responses and how they become disordered in lupus, we could learn to develop individualized combinations of these agents for each patient, using strategic blood testing to select the treatments and guide their dosing. The technology is here. The impediments include remaining difficulties in designing and carrying out lupus trials and an understandable resistance to changing the paradigm of how treatments are developed. But solutions are being formulated and the paradigm is indeed shifting.
Disclosure of Interest J. Merrill Grant/research support from: Bristol Myers Squibb, Pfizer, Genentech, UCB, Consultant for: Genentech, Bristol Myers Squibb, Pfizer, GSK, UCB, Lilly, MedImmune