Around one in every thousand people in the UK suffer from a type of lupus. There are four primary types of the disease, and identifying which one someone is suffering from and how severe it is from can require a number of tests.
For a long time, new treatments for lupus were not on the horizon. It was over fifty years before a new treatment was developed and approved in 2011. Now, there are more potential lupus treatments in development than ever before, with trials and studies happening nearly continuously.
But what are the different types of lupus, and what are these new potential treatments and technologies? Here is a closer look at the future of lupus treatment, and how people who suffer from all types of lupus may find relief from their symptoms in the years to come.
The Different Types Of Lupus
The most common form of lupus in people across the world is Systemic Lupus Erythematosus or SLE, which is often the type of lupus people talk about when they discuss the disease. It can affect many important organs in the body, most notably the kidneys, and causes inflammation and swelling in the joints, which can be very painful.
Discoid Lupus Erythematosus (DLE), which is sometimes called chronic cutaneous lupus erythematosus, is a skin condition that primarily affects the scalp, face, and neck but can also be found in and around the ears and on the torso in some cases. It causes scaly and dry skin that will crack and then heal, often leaving discolouration behind. DLE on the scalp can also lead to permanent hair loss.
There are a number of symptoms these two forms of lupus share, and they also respond to similar treatments. Drug-Induced Lupus Erythematosus and Neonatal Lupus Erythematosus are both rare conditions that do not affect many people. Drug-Induced Lupus Erythematosus is similar to SLE but caused by a reaction to some prescription drugs.
Neonatal Lupus Erythematosus is very rare and affects some babies in the womb, as their mother’s antibodies act upon their child’s heart conduction system. When they are born, the child may have skin rashes, a low blood cell count, or even liver problems.
Anifrolumab
One of the biggest breakthroughs in the treatment of lupus came just a couple of years ago. This new drug has the potential to change the lives of sufferers of moderate to severely active Systemic Lupus Erythematosus or SLE.
Two studies were conducted to assess the efficacy and safety of anifrolumab, the new medication developed by AstraZeneca. These studies were called TULIP I and TULIP II, after the full name of the study; the ‘Treatment of Uncontrolled Lupus via the Interferon Pathway’. The results of both studies have been peer-reviewed and published in the prestigious medical journals The Lancet, for TULIP I, and The New England Journal of Medicine for TULIP II.
The drug has been described as a major breakthrough in the treatment of lupus and its symptoms and has the potential to ease the pain and stiffness in joints as well as the tiredness and fatigue associated with the condition.
Previous studies on lupus showed that people with the condition had increased levels of interferons in their bodies, which are normally used to fight viral infections. Anifrolumab blocks the effects of these interferons, and this eases the symptoms of lupus in patients.
Belimumab
This drug was first approved for use to treat lupus in America ten years ago, and it took another five years for approval for use in the UK. It is now slowly being prescribed to treat more and more people with lupus, and early signs are that it can be very effective for most sufferers.
Belimumab is also known as Benlysta, and is a ‘biologic’ therapy. When it was developed by GlaxoSmithKline it was the first new drug to treat lupus in 50 years, and news of its development brought a lot of hope to the lupus community. Belimumab is usually prescribed alongside other lupus treatments and is administered by either intravenous drip or by a sub-cutaneous injection that patients can administer themselves at home.
In lupus, the body’s immune system begins to produce antibodies that attack body tissue which causes inflammation and joint pain. Belimumab reduces the activity of B-cells, which are a type of white blood cell that produces the antibodies that attack the tissue. This reduces the inflammation, which lessens the severity of lupus symptoms, and the pain and discomfort that comes with them.
This drug was initially only to be prescribed to people with active auto-antibody positive systemic lupus erythematosus, but recently NICE or The National Institute for Health and Care Excellence has allowed its use for patients with other forms of lupus who have not had any success with other treatments.
Rituximab
This drug was developed as a targeted cancer treatment and has been used to treat people with chronic lymphocytic leukaemia (CCL) and some forms of non-Hodgkin lymphoma (NHL).
A study called the BEAT Lupus trial was completed in a collaboration between GlaxoSmithKline and the Versus Arthritis organisation. It found that using a combination of rituximab and belimumab was very effective at treating lupus and alleviating the symptoms in sufferers.
Both rituximab and belimumab are ‘biologic’ drugs, which means they are made from substances that are naturally occurring in the body. By treating patients first with rituximab and then with belimumab, the BEAT trial found a threefold reduction in lupus flareups when compared to the test group that received neither drug.
This was the United Kingdom’s first drug trial of a combination of biologic drugs for the treatment of lupus, and is considered a great success. It has led to a larger clinical trial to prove the effectiveness of this new treatment which should be available to UK systemic lupus erythematosus sufferers in the near future.
Blisibimod
This drug works in a similar way to belimumab but shows the potential to be effective at treating systemic lupus erythematosus as well as other types of lupus, such as discoid lupus erythematosus (DLE). The treatment has been shown to be particularly effective for people who have severe cases of lupus and can ease their symptoms, radically improving their quality of life.
Like belimumab, this drug reduces the number of active B-cells in the body that attack tissue and cause joint pain and inflammation. This drug shows signs of being more effective at lower doses than belimumab, and could be both a safer and cheaper treatment for lupus sufferers.
Early trials have shown that there are some adverse effects to using blisibimod. These include upper respiratory tract infections, urinary tract infections (UTIs), diarrhoea, and skin reactions around the injection sites used to administer the drug.
Though more trials need to be completed, there is some potential in using blisibimod to treat all types of lupus. When future studies are finished, the drug may well become a common prescription for patients with lupus symptoms.
These treatments are just the beginning. With so many lupus patients, drug manufacturers cannot afford to ignore this disease as they did for so long before. As research into the causes of the disease increases, it pushes forward new treatments and technological innovations that can reduce the suffering of millions of people across the world. Soon lupus patients will have a suite of drugs and treatments available to them, and doctors will be able to create tailored treatment plans for each individual case. There is finally light at the end of the tunnel for lupus sufferers and their families.
