News & Views

In clinical trials testing new treatments for systemic lupus erythematosus (SLE), the failure of the 15-year drug development program for Riquent^™ (abetimus sodium) is the latest in a string of disappointments for a disease that has seen no new drugs approved in over 50 years.

Two consecutive trials of rituximab, a B-cell-depleting anti-CD20 monoclonal antibody, have threatened the future of B-cell-targeted therapy for systemic lupus erythematosus (SLE). While rumors of the demise of this approach might be greatly exaggerated, the outcomes of these studies should force academics and the pharmaceutical industry back to the drawing board.

The comprehensiveness of clinical guidelines is a major determinant of their usefulness, but covering a broad range of topics in depth can prove difficult.

A set of recommendations developed by an international panel of experts could have an impact on the care of patients with systemic sclerosis.

The current treatment options for Raynaud phenomenon are often ineffective and can have undesirable adverse effects. Topical, or transdermal, treatments that increase digital blood flow without systemic adverse effects are, therefore, an attractive option. A novel topical nitroglycerin formulation has shown promise in treating Raynaud attacks.

Tumor necrosis factor inhibitors are an effective treatment for psoriatic arthritis, but no single agent is effective in all patients. Novel therapies that target other cytokines have now been tested, with encouraging results.

Opioids are increasingly used for the treatment of chronic noncancer pain, but this practice remains controversial. A new set of clinical recommendations attempts to guide clinicians through the issues.

Studies performed during the past 2 years have provided a deeper understanding into the role of CTLA-4, which is expressed on regulatory T cells, in preventing autoimmunity, and also provide mechanistic insight into protein-based therapeutics such as abatacept for rheumatic diseases.

Achieving effective maintenance therapy with minimal adverse effects for patients with antineutrophil cytoplasmic autoantibody associated vasculitis is a major challenge facing the vasculitis community. A study by Pagnoux et al. shows that azathioprine and methotrexate have similar efficacy and adverse event profiles when used for remission maintenance in these patients.

The FDA's approval of milnacipran reflects advances in the development of drugs aimed at modulating pain circuitry in fibromyalgia.

Practice in relation to administration of methotrexate varies considerably despite its prominent place in the treatment arsenal for various rheumatic diseases. A multinational initiative has developed recommendations, based on the literature and in consultation with a large panel of rheumatologists, for use of this drug.

Tumor necrosis factor inhibitors are fast acting, highly effective and well tolerated by the majority of patients, but their safety in pregnant women remains a matter of debate. The latest research weighs in on the issue.

The ability to conduct genetic association studies on a genome-wide scale has revolutionized approaches to reveal the genetic basis of autoimmune diseases. A comparison by Zhernakova and colleagues of the known susceptibility genes in 11 immune-related diseases reveals evidence for shared gene effects and common pathogenetic mechanisms.