Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Opinion
  • Published:

Systemic lupus erythematosus clinical trials—an interim analysis

Abstract

Since the current standards for drug approval were established nearly half a century ago, no drug has been approved for the treatment of systemic lupus erythematosus (SLE). Despite this sobering history, interest in drug development for SLE has heightened in the past few years. This enthusiasm has been fueled in large part by the success of biologic therapy for rheumatoid arthritis and other autoimmune diseases. Unfortunately, despite considerable clinical trial activity, this interest has not yet translated into the discovery of an effective treatment for SLE. This article provides an analysis of the major clinical trials in SLE, and offers an interpretation of the results that could illuminate the path forward.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Petri, M. A. et al. Effects of prasterone on corticosteroid requirements of women with systemic lupus erythematosus: a double-blind randomized, placebo-controlled trial. Arthritis Rheum. 46, 1820–1829 (2002).

    Article  CAS  Google Scholar 

  2. Petri, M. A. et al. Effects of prasterone on disease activity and symptoms in women with active systemic lupus erythematosus. Arthritis Rheum. 50, 2858–2868 (2004).

    Article  CAS  Google Scholar 

  3. Appel, G. B. et al. Mycophenolate mofetil versus cyclophosphamide as lupus nephritis induction treatment. J. Am. Soc. Nephrol. (in press).

  4. Wallace, D. J. et al. Belimumab (Lymphostat-B) shows bioactivity and reduces SLE disease activity [Abstract]. Presented at the Annual Congress of the European League Against Rheumatism: Amsterdam, The Netherlands (22 June, 2006).

  5. Wallace, D. J. et al. Belimumab reduces SLE disease activity and demonstrates durable bioactivity at 76 weeks [Abstract]. Presented at the 70th Annual Scientific Meeting of the American College of Rheumatology: Washington, DC (14 November, 2006).

  6. Merrill, J. T. et al. Efficacy and safety of rituximab in patients with moderately to severely active systemic lupus erythematosus (SLE): results from the randomized, double-blind phase II/III study (EXPLORER) [Abstract L12]. Program and abstracts of the American College of Rheumatology 2008 Annual Scientific Meeting: San Francisco, CA (24–29 October, 2008).

  7. Merrill, J. T. et al. The efficacy and safety of abatacept in SLE: results of a 12-month exploratory study [Abstract L15]. Program and abstracts of the American College of Rheumatology 2008 Annual Scientific Meeting: San Francisco, CA (24–29 October, 2008).

  8. A study to evaluate the efficacy and safety of rituximab in subjects with ISN/RPS Class III or IV lupus nephritis (LUNAR). http://www.clinicaltrials.gov/ct2/show/NCT00282347

  9. Study of LJP 394 in lupus patients with history of renal disease (ASPEN). http://www.clinicaltrials.gov/ct/show/NCT00089804

  10. Chan, T. M. et al. Efficacy of mycophenolate mofetil in patients with diffuse proliferative lupus nephritis. Hong Kong–Guangzhou Nephrology Study Group. N. Engl. J. Med. 343, 1156–1162 (2000).

    Article  CAS  Google Scholar 

  11. Contreras, G. et al. Sequential therapies for proliferative lupus nephritis. N. Engl. J. Med. 350, 971–980 (2004).

    Article  CAS  Google Scholar 

  12. Ginzler, E. M. et al. Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis. N. Engl. J. Med. 353, 2219–2228 (2005).

    Article  CAS  Google Scholar 

  13. Chatham, W. et al. Belimumab (fully human monoclonal antibody to BLyS) improved or stabilized systemic lupus erythematosus (SLE) disease activity over 3 years of therapy (Abstract). Arthritis Rheum. 58, S573 (2008).

    Google Scholar 

  14. Smith, K. G., Jones, R. B., Burns, S. M. & Jayne, D. R. Long-term comparison of rituximab treatment for refractory systemic lupus erythematosus and vasculitis: remission, relapse, and re-treatment. Arthritis Rheum. 54, 2970–2982 (2006).

    Article  CAS  Google Scholar 

  15. Ng, K. P. et al. B cell depletion therapy in systemic lupus erythematosus: long-term follow-up and predictors of response. Ann. Rheum. Dis. 66, 1259–1266 (2007).

    Article  CAS  Google Scholar 

  16. Daikh, D. I. & Wofsy, D. Reversal of murine lupus nephritis with CTLA4Ig and cyclophosphamide. J. Immunol. 166, 2913–2916 (2001).

    Article  CAS  Google Scholar 

  17. Schiffer, L. et al. Short term administration of costimulatory blockade and cyclophosphamide induces remission of systemic lupus erythematosus nephritis in NZB/W F1 mice by a mechanism downstream of renal immune complex deposition. J. Immunol. 171, 489–497 (2003).

    Article  CAS  Google Scholar 

  18. Austin, H. A. et al. Therapy of lupus nephritis. Controlled trial of prednisone and cytotoxic drugs. N. Engl. J. Med. 314, 614–619 (1986).

    Article  Google Scholar 

  19. Illei, G. G. et al. Combination therapy with pulse cyclophosphamide plus pulse methylprednisolone improves long-term renal outcome without adding toxicity in patients with lupus nephritis. Ann. Intern. Med. 135, 248–257 (2001).

    Article  CAS  Google Scholar 

  20. Illei, G. G. et al. Renal flares are common in patients with severe proliferative lupus nephritis treated with pulse immunosuppressive therapy: long-term followup of a cohort of 145 patients participating in randomized controlled studies. Arthritis Rheum. 46, 995–1002 (2002).

    Article  CAS  Google Scholar 

  21. Biomarker-linked outcomes of Cellcept in lupus arthritis. http://www.clinicaltrials.gov/ct2/show/NCT00594932

Download references

Acknowledgements

The authors gratefully acknowledge support from the Rosalind Russell Medical Research Center for Arthritis at the University of California, San Francisco.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to David Wofsy.

Ethics declarations

Competing interests

D. Wofsy has acted as a consultant for Aspreva, Bristol-Myers Squibb, Genentech, Merck-Serono and ZymoGenetics. M. Dall'Era has acted as a consultant for Genentech, Merck-Serono and ZymoGenetics.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dall'Era, M., Wofsy, D. Systemic lupus erythematosus clinical trials—an interim analysis. Nat Rev Rheumatol 5, 348–351 (2009). https://doi.org/10.1038/nrrheum.2009.79

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrrheum.2009.79

This article is cited by

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing