The recent history of systemic lupus erythematosus is marked by the development of promising new agents based on research into the underlying biology of the disease, which have seldom carried their promise into successful clinical trials. However, over the last year there have been encouraging data on two biologics, epratuzumab and atacicept, together withe a potential new indication for rituximab in early treatment of lupus nephritis. These issues will be discussed.
Observational studies in large numbers of patients with SLE are also important. The Systemic Lupus International Collaborative Clinics (SLICC) group has published a series of papers based on an inception cohort of 1600 patients followed for up to 12 years. These papers tell us about facets of the natural history of the condition, such as development of nephritis and mood disorders.
A multi-national group developed Treatment-to-Target guidelines for SLE. While broad-ranging, many of these targets are likely to be feasible in clinical practice.
In contrast to SLE, there are very limited options for treatment of the antiphospholipid syndrome (APS). Anticoagulation with warfarin or heparin remains the only form of therapy with a secure evidence base. However, efforts to develop new treatments are progressing and trials of alternative anticoagulants such as rivaroxaban may be of particular interest.
Another challenge in the management of APS lies in the fact that the serological tests used to diagnose it are imperfect and it can be difficult to decide which patients testing positive in the anti-cardiolipin, anti-beta-2-glycoprotein I or lupus anticoagulant assays actually require long-term anticoagulation. A series of authoritative reports on the diagnosis and treatment of APS were published as an outcome of taskforces set up at the 2013 international APS conference in Rio de Janeiro and some of their conclusions will be discussed.
The concept of “seronegative” APS, i.e. patients with typical features of APS but who test negative in the standard assays is a controversial one. However, some recent papers suggest that at least a proportion of these patients do have antibodies that can be detected by novel assays.
Disclosure of Interest None declared