Scientists find an indicator in blood that could guide treatment for Lupus

Scientists at University College London have discovered why some Lupus patients may react positively to certain drugs. This knowledge could make sure that patients get the treatment that’s most likely to work for them.  

Why is this research important? 

There are two main types of lupus, but systemic lupus erythematosus (SLE) is the most common. Lupus (SLE) is a long-term condition that causes inflammation across the body.

It’s called an autoimmune condition because the immune system, which normally protects us against infection and illness, starts to attack the body’s own tissues instead.  

If you have lupus (SLE), you might experience joint and muscle pain, extreme tiredness, as well as other symptoms which can get in the way of day-to-day life.

Plus, how severe your lupus (SLE) symptoms are, as well as your response to different treatments, can be hard to predict because it varies from person to person.  

For this reason, researchers believe that personalised medicine could make a real difference to people who have lupus (SLE).  

Personalised medicine is all about tailoring the treatment you receive based on your individual needs, so that it’s more effective and you get fewer side effects.  

What were the main findings? 

If you have lupus (SLE), you may receive drugs such as rituximab or more recently belimumab. These target an immune cell which is involved in lupus called B-cells. 

Rituximab is generally recommended for people who are not responding to other treatments. However, some people who take rituximab find that the inflammation can flare up after treatment.  

The BEAT LUPUS trial aimed to see whether treating people with belimumab after rituximab could reduce these flare ups. The BEAT LUPUS trial gave 52 patients either: 

• a combination of rituximab and belimumab.
• or rituximab alone.

This allows us to compare whether the combination of drugs is better than just one. Then the scientists measured how effective the different treatments were against lupus (SLE) after 52 weeks.

When looking at the group who received the combination of rituximab with belimumab, the trial found that a greater number of patients had a positive response compared to rituximab alone.

The scientists wanted to see if there was a way to predict which people may respond best to the combination of treatments.

To do this the researchers looked at how each person in the study responded to treatment. They then used artificial intelligence to identify any biological markers in common between patients who had similar responses.

Biological markers are indicators that help to tell us what is going on in the body. They can often be measured in the blood or urine.

The group treated with rituximab and belimumab had less of a biological marker of lupus (IgG anti-double stranded DNA antibodies) in their blood compared with the placebo group. Plus, they had fewer severe flares.

The researchers found one marker in the blood (an antibody called IgA2 anti-dsDNA) was an effective indicator that someone will have a better response to a combination of both rituximab and belimumab. 

How will the findings benefit patients? 

In future, it’s hoped that healthcare teams could use this marker to help personalise treatment plans for people with lupus (SLE).

It would allow them to offer a combination of both rituximab and belimumab only when it is most likely to be successful in treating someone with lupus (SLE). 

Researchers hope to test this in a larger trial and eventually provide a new option for patients with lupus (SLE). 

Professor Mike Ehrenstein, the lead on this study, said: 

“We know that combination drug treatment with rituximab followed by belimumab can reduce disease activity in lupus, and now we've found that we can predict who will best respond to this combination of drugs, meaning we can give treatment in a more targeted way. 

"Targeting the patients most likely to benefit from this treatment presents the NHS with a more cost-effective way of treating lupus.

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