Biologics in lupus: which and for whom?
With the regulatory approval of belimumab it may be said that the treatment of SLE has (finally!) entered the biologic age. In addition to this approved agent several other biologics have been used off-label, most notably rituximab. Two large randomized clinical trials of belimumab achieved their primary endpoints, whereas two trials each with rituximab and abatacept were nominally negative. However, in some of these trials trends were observed that suggest efficacy may nonetheless be present in certain subsets of patients. Several other biologics are currently in phase II or III clinical trials. So clinicians face important questions in the management of their patients: which biologics to consider, and for whom.
In this lecture, I will present some of the evidence that may help clinicians decide on these issues and use clinical cases to illustrate the certainties and uncertainties of biologics in SLE.
Disclosure of Interest R. Van Vollenhoven Grant/research support from: AbbVie, BMS, GSK, MSD, Pfizer, Roche, UCB, Consultant for: AbbVie, BMS, GSK, Lilly, MSD, Pfizer, Roche, UCB