{"id":22826,"date":"2020-09-18T07:09:00","date_gmt":"2020-09-18T07:09:00","guid":{"rendered":"https:\/\/bengalnewstimes.com\/?p=22826"},"modified":"2020-09-18T07:09:00","modified_gmt":"2020-09-18T07:09:00","slug":"companion-drug-might-help-prevent-kidney-complications-of-lupus","status":"publish","type":"post","link":"https:\/\/bengalnewstimes.com\/?p=22826","title":{"rendered":"Companion Drug Might Help Prevent Kidney Complications of Lupus"},"content":{"rendered":"

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\"NewsBy Amy Norton<\/b>
HealthDay Reporter<\/i><\/p>\n

WEDNESDAY, Sept. 16, 2020 (HealthDay News)<\/p>\n

Adding a newer drug to standard therapy might help control kidney complications caused by the autoimmune disease lupus<\/a>, a new clinical trial suggests.<\/p>\n

The researchers found that adding the drug, called belimumab<\/a>, improved patients’ likelihood of responding to treatment. That meant a reduction in protein in the urine<\/a> — a tell-tale sign of kidney inflammation — and no significant loss in kidney function.<\/p>\n

Experts said the results add to evidence that belimumab<\/a> helps shield the kidneys from the ravages of lupus<\/a>.<\/p>\n

In the most common form of the disease — called systemic lupus erythematosus<\/a> (SLE<\/a>) — the immune system mistakenly produces antibodies against the body’s own tissue. The onslaught can have widespread effects, damaging the skin, joints, heart<\/a>, lungs<\/a> and kidneys.<\/p>\n

Up to 60% of people with SLE<\/a> develop kidney inflammation known as nephritis, according to the Lupus<\/a> Foundation of America.<\/p>\n

There are drugs<\/a> to treat it, and the prognosis has improved in recent years, said Dr. Michael Ward of the U.S. National Institute of Arthritis<\/a> and Musculoskeletal and Skin Diseases, in Bethesda, Md.<\/p>\n

But, he said, better treatments are still needed. Around 40% of people with more-severe lupus<\/a> nephritis develop end-stage kidney failure<\/a>.<\/p>\n

Ward wrote an editorial published with the new findings Sept. 17 in the New England Journal of Medicine<\/i>.<\/p>\n

Belimumab is already approved for controlling lupus<\/a> symptom flares in patients who do not have nephritis. Ward said the new findings suggest that patients already on the drug might get some added benefit for their kidneys.<\/p>\n

But he said the question of whether nephritis patients should add<\/i> belimumab is trickier.<\/p>\n

“I’d describe the benefit as modest,” Ward said. And it’s unclear, he added, which nephritis patients could get that benefit.<\/p>\n

The standard treatment for lupus<\/a> nephritis includes two drugs<\/a> that suppress the immune system: intravenous cyclophosphamide<\/a> and mycophenolate mofetil<\/a>, an oral drug.<\/p>\n

Belimumab, first approved in 2011, also suppresses the immune system but in a more specific way. It’s a lab-engineered antibody, given by IV or injection, and it quiets overactivity in immune system cells that produce antibodies.<\/p>\n

The trials that spurred the drug’s approval did not include people with full-blown nephritis. But some patients had “low-grade” kidney disease<\/a>, said Dr. Richard Furie, lead researcher on the new trial.<\/p>\n

And in those patients, there were signs belimumab benefited the kidneys.<\/p>\n

That gave the impetus for this trial, said Furie, who is chief of rheumatology<\/a> at Northwell Health, in Great Neck, N.Y.<\/p>\n

His team recruited 448 lupus<\/a> nephritis patients in 21 countries and randomly assigned them to one of two groups: One had monthly belimumab infusions added to their regular treatment; the other received placebo infusions.<\/p>\n

GlaxoSmithKline, which markets the drug as Benlysta<\/a>, funded the trial.<\/p>\n

After two years, the belimumab group was faring better, the researchers found. Overall, 43% were showing a “primary efficacy renal response,” compared to 32% of placebo patients.<\/p>\n

That means patients had stable kidney function and a drop in protein in their urine, Furie explained.<\/p>\n

But, Ward pointed out, the effect was seen only in patients who had the drug added to mycophenolate — not those on cyclophosphamide<\/a>. And it’s not clear how to read that.<\/p>\n

“It might mean belimumab only enhances the effects of mycophenolate,” Ward speculated.<\/p>\n

Or, he said, it could mean that belimumab only helps patients with less-severe kidney disease<\/a>: Doctors may have prescribed cyclophosphamide to patients with worse disease.<\/p>\n

Belimumab did appear to be safe. It had expected side effects, like respiratory and urinary tract infections<\/a>. But there was no increase in serious side effects compared to the placebo — a finding Ward called “reassuring.”<\/p>\n


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IMAGES<\/h4>\n


\n Systemic Lupus Erythematosus<\/span>
\n Browse our medical image collection to see of photos of autoimmune, vascular, and other systemic conditions<\/span>
\n See Images<\/span>
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A long-term question is whether adding belimumab would help prevent progression to advanced kidney failure<\/a>. Ideally, both Furie and Ward said, a trial would look at that. But realistically, that’s tough to pull off, since the complication can take many years to arise.<\/p>\n

Based on these results, Furie said, “one could argue that nephritis patients should have (belimumab) in addition to the standard of care.”<\/p>\n

In the real world, though, there is also the matter of cost. Like other “biologic” drugs, belimumab is expensive — totaling about $35,000 per year.<\/p>\n

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Copyright \u00a9 2020 HealthDay. All rights reserved.<\/p>\n


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References<\/p>\n


\n SOURCES: Richard Furie, MD, chief, rheumatology, Northwell Health, and professor, medicine, Donald and Barbara Zucker School of Medicine at Hofstra\/Northwell, Great Neck, N.Y.; Michael Ward, MD, MPH, chief, Clinical Trials and Outcomes Branch, U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Md.; New England Journal of Medicine<\/i>, Sept. 17, 2020 \n <\/p>\n<\/p><\/div>\n