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Optimization of current and future therapy for autoimmune diseases

Nature Medicine volume 18, pages 59–65 (2012)Cite this article

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There are multiple immune-based therapeutics available for some of the most prevalent autoimmune diseases, but for others, there are few or no approved immune therapies. This dichotomy poses discrete challenges. First, for diseases in which multiple therapy choices exist, a rational decision tree is required to select the best therapy. Second, we must devise new strategies for the autoimmune diseases that have the highest unmet clinical need. This commentary outlines new strategies for designing more efficient and selective approaches for immune therapy of autoimmune diseases.

In many diseases considered to be autoimmune, including rheumatoid arthritis, psoriasis and multiple sclerosis, there have been numerous successes in developing targeted immune therapies over the past two decades that have led to an improved range of choices for clinical treatment1,2,3. However, there are still unmet clinical needs in these diseases. First-line therapies are not effective in all patients with autoimmune diseases, and the choice of which medication to prescribe poses challenges for physicians who are largely left to choose among treatments with distinctly different mechanisms without having a great deal of mechanistic information about the biology of an individual patient.

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Figure 1: The same therapies can have different effects in different autoimmune diseases.
Figure 2: Optimizing combination strategies, using T1D as an example.

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Authors and Affiliations

  1. Lawrence Steinman is at the Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA.,

    Lawrence Steinman

  2. Joan T. Merrill is at the Clinical Pharmacology Research Program, Oklahoma Medical Research Foundation, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.,

    Joan T Merrill

  3. Iain B. McInnes is at the Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.,

    Iain B McInnes

  4. Mark Peakman is at the Department of Immunobiology, King's College London, London, UK and the National Institute for Health Research Comprehensive Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust and King's College London, London, UK.,

    Mark Peakman

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Correspondence to Lawrence Steinman.

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Steinman, L., Merrill, J., McInnes, I. et al. Optimization of current and future therapy for autoimmune diseases. Nat Med 18, 59–65 (2012). https://doi.org/10.1038/nm.2625

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