June 12, 2019
As reported by The Rheumatologist, Dr. Richard Furie provided his perspective on clinical trials in lupus in a talk for the American College of Rheumatology meeting.
“Lupus is being attacked in a very eclectic manner. It’s just fascinating to me how many different approaches are being taken to attack this condition,” he said.
Regarding the failure of the TULIP-1 anifrolumab trial, which targeted the type 1 interferon pathway, Dr. Furie commented, “It actually would make a lot of sense to target the receptor, because then you’re blocking all type 1 interferons. Whereas, if you just target alpha interferon, for example, you have four other subtypes of the type 1 interferon that can signal through the receptor,” Dr. Furie said. “So one would expect greater interferon inhibition by targeting the type 1 receptor.”
“It really shocked the lupus community, because we had great expectations for this particular drug,” Dr. Furie said. “There have been a lot of analyses performed to find out why it failed.” Those findings and results of a companion phase 3 study will likely be out soon, he noted.
He mentioned four main problems with lupus clinical trials. For one thing, especially when it comes to extra-renal disease, lupus activity is “often overstated,” he said. For another, patients are on several background therapies. “That blunts our ability to discriminate” the effect of one therapy from another, Dr. Furie said. The complexity of the disease is also a factor. “As opposed to rheumatoid arthritis and psoriatic arthritis, there may be more pathways active in lupus,” he said. The field also needs better endpoints in its clinical trials.
Read more in The Rheumatologist