As we look forward to reporting more news to patients, family members, and caregivers in 2019, here are the Top 10 most-read articles of 2018.
A study from China used cardiac magnetic resonance (CMR) techniques to find that systemic lupus erythematosus (SLE) patients already show signs of heart impairment at diagnosis. Specifically, the imaging tests revealed structural and functional changes in the heart muscle, including signs of fibrosis, or scarring, and edema (swelling) in the right ventricle of newly diagnosed patients. The extent of heart changes correlated with SLE duration and stage. The team suggested that the CMR techniques could help detect markers of injury before the occurrence of fibrosis and functional worsening.
No. 9 — “Add-on Lupuzor Fails Primary Goal but Shows Some Positive Results in Phase 3 Trial for SLE”
ImmuPharma’s investigational treatment Lupuzor (rigerimod, or IPP-201101) received significant attention from our readers in 2018. Unlike other immunomodulatory approaches, Lupuzor suppresses the activation of auto-reactive — against the body’s own tissues — immune T-cells while sparing healthy cells. Its Phase 3 trial (NCT02504645) found that, in combination with standard therapy, treatment with 200 micrograms of Lupuzor every four weeks for 48 weeks did not provide a significant reduction in SLE disease activity compared with standard care alone. However, Lupuzor was safe, leading to no serious adverse events. Also, in patients with anti-dsDNA autoantibodies — a biomarker for SLE — Lupuzor led to superior clinical response and remission rate than placebo.
A two-month treatment with the antimalarial medication hydroxychloroquine (HCQ) helped normalize the levels of pro-inflammatory molecules, which are elevated in the active phase of lupus. HCQ (400 mg per day) was used in combination with a limited dose of the corticosteroid prednisolone. Specifically, the results showed that HCQ lowered the levels of the pro-inflammatory molecules interleukin (IL)-1beta, IL-6, and TNF-alpha, as well as of anti-dsDNA autoantibodies. HCQ also increased the amount of CH50 — a type of complement protein, whose low levels are markers of autoimmune diseases such as SLE — while reducing SLE disease activity.
Levels of anti-extractable nuclear antigen (anti-ENA) autoantibodies correlate with various clinical characteristics of lupus, according to a study of 70 SLE patients. These autoantibodies are found in the blood and react with proteins in the cell’s nucleus. The higher the levels of anti-ENA autoantibodies, the greater the disease activity and duration, the frequency of headaches, the levels of 24-hour urinary proteins (indicative of impaired kidney function), the degree of inflammation, and the presence of kidney inflammation — or lupus nephritis — a major complication of SLE.
Another story about Lupuzor made our Top 10 list: The completion of its Phase 3 trial in 200 lupus patients and the announcement of an extension study. This preceded the release of the trial’s results, which we reported in No. 9 of this list. The follow-up study involves patients who completed the Phase 3 trial and was requested by both patients and researchers.
Research from Spain reported that virgin olive oil (VOO), particularly its phenol components, showed anti-inflammatory properties in an SLE mouse model and in human immune cells called monocytes and macrophages. In mice, VOO correlated with a lower release of nitrite — known for blood vessel widening and oxidative stress — and of pro-inflammatory molecules TNF-alpha and IL-17. Its phenol fraction led to similar reductions in human cells, and lowered the production of inducible nitric oxide synthase, an enzyme typically at high levels in inflammation. This phenol fraction further favored anti-inflammatory macrophages over the pro-inflammatory subtype.
The rheumatoid arthritis treatment baricitinib (brand name, Oluminant, by Eli Lilly) improved symptoms of SLE in a Phase 2 trial (NCT02708095). A total of 314 patients were included, taking either a placebo, or 2 mg or 4 mg of baricitinib. After 24 weeks, 67% of patients on the higher dose and 58% of those on the lower dose were free from arthritis or rash associated with SLE. In the placebo group, 53% also showed this response. However, patients on either dose of baracitinib had higher chances of adverse events, including serious side effects, than the placebo group. A Phase 3 trial (NCT03616912) of baricitinib in this patient population is currently recruiting participants.
A study looking at how pain relates to cognitive health in 115 SLE patients found that pain-mediated sleep impairment and depression affect cognition in these patients. Disease activity and stress were also directly linked to cognitive dysfunction. The team suggested treatment with non-pharmacologic approaches such as cognitive behavioral therapies for depression and sleeping difficulties to preserve higher-level thinking.
The second most-read article of 2018 described the first link between a blood biomarker and fatigue in SLE patients. Researchers showed that functional iron deficiency, assessed by the size variation of red blood cells, correlated with increased fatigue scores in three groups of juvenile- or adult-onset patients of various ages in the U.K. and Australia.
The most-read article described a correlation between infection with the Epstein-Barr virus (EBV) and a greater risk for SLE and six other major autoimmune diseases, including multiple sclerosis, rheumatoid arthritis, juvenile idiopathic arthritis, inflammatory bowel disease, celiac disease, and type 1 diabetes. EBV, which causes mononucleosis, mostly invades and takes control of immune B-cells, altering them to survive and replicate. The team found that a protein produced by EBV, called EBNA2, together with molecules called transcription factors (which control gene expression) bind to multiple locations along the human genome that are associated with these autoimmune disorders.
At Lupus News Today, we hope to continue to provide information in 2019 to educate, inform, and improve the lives of everyone dealing with lupus.
We wish all our readers a happy and inspiring 2019.