Applying Precision Medicine to Systemic Lupus Erythematosus

Michelle Petri, MD, MPH, who is the director or the Johns Hopkins Lupus Center and professor of Medicine at the Johns Hopkins University School of Medicine, Baltimore, Maryland, said there could be a significant improvement in the long run in terms of morbidity and mortality through pharmacogenetics.  “Initially it may be very expensive.  If we think long-term though in terms of preventing dialysis it will be worth it,” Dr Petri told Rheumatology Advisor.

Sangeeta Sule, MD, who is an associate professor of Pediatrics at the Johns Hopkins University School of Medicine, said there is incredible promise for preventing long-term kidney complications, such as hypertension and dialysis with pharmacogenomics and pharmacotherapy.  “Pharmacogenomics and pharmacotherapy are coming of age in pediatric lupus. I think these treatment options will provide a significant benefit to children with SLE as therapies could be tailored for each individual,” Dr Sule told Rheumatology Advisor.  

Potential Influence of Precision Medicine on Pediatric Rheumatic Diseases

Randy Cron, MD, PhD, director of the University of Alabama Birmingham (UAB’s) Division of Pediatric Rheumatology, Birmingham, Alabama, said currently most children are treated rather aggressively and he has seen a remarkable change in the last couple of years with rituximab.   “It appears to help with lupus nephritis and other aspects of lupus as well,” he said in an interview with Rheumatology Advisor.  

“Some kids have had their lupus completely going away and I have never seen that before.  For me there is reason for optimism.  I have been under impressed with some of the newer drugs that get a lot of attention, but rituximab seems to work for the proteinuria problem as well as other aspects of the nephritis.”

Precision medicine will be changing clinical practice significantly and maybe it is time to have all babies’ genomes sequenced at birth and assessed for risk and what medical therapies may be better than others.  “It is a nice idea and I think we will get there at some point, but we have so much left to understand,” said Dr Cron.

Related Articles

References

  1. Raj P, Rai E, Song R, et al. Regulatory polymorphisms modulate the expression of HLA class II molecules and promote autoimmunity. eLife. 2016;5:e12089. doi:10.7554/eLife.12089
  2. Biesen R, Rose T, Hoyer BF, Alexander T, Hiepe F. Autoantibodies, complement and type I interferon as biomarkers for personalized medicine in SLE. Lupus. 2016;25(8):823-9.