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Living with Lupus

     Presented by:
  Lauren Kennish, MD
     Rheumatology
    August 22, 2012
Lupus Outline

•   What is Lupus?
•   How Lupus is diagnosed
•   Symptoms of Lupus
•   Treatment options
•   Living with Lupus
•   New developments
What is Lupus?
• Lupus is an autoimmune disease
• Autoimmune disease:
  Immune system incorrectly targets your own
    tissues and organs

              Antibodies form and attack cells

                 Inflammation/Swelling

                    Damage/Disease
What is Lupus?
• Systemic Lupus Erythematosus
• Chronic condition
• Can affect almost any organ
     Brain        •Skin
     Heart
                   •Musculoskeletal
     Lung
     Kidney       •Blood
• Variable in presentation and
course        Mild           Severe
What is Lupus?
  • 1-10 in 10,000 in US; 300,000-1 million affected
  • Diagnosed in ages 15-45
  • Females (9x) > Males (1x)
  • More prevalent: African
  Americans, Hispanics,
  Asians > Caucasians




Harrisons Internal Medicine, 18th ed. Longo et al.   www.CDC.gov   Bernatsky et al. Rheumatology, 2007.
What Causes Lupus?
• Unknown
     Hereditary?
     Environment?
• Known Triggers:
     Smoking
     Sunlight
     Hormones
     Infection
     Stress
     Sulfa medications
Symptoms of Lupus
• Skin
     Rash –
       • Malar (butterfly)
       • Discoid
       • Photosensitivity
     Mouth/Nose sores
     Hair loss


• Musculoskeletal System
     Arthritis- joint pain and swelling
     Muscle weakness

                                   American College of Rheumatology www.rheumatology.org
Symptoms of Lupus
• Kidney
     Lupus nephritis - change in urine, swelling, high
      blood pressure
• Central Nervous System
     Seizures, Psychosis
     Headaches, neuropathy
• Heart/Lungs
     Serositis - chest pain, trouble breathing
     Lung disease, heart valve disease
• Blood                                              www.rheumatology.org


     Anemia, leukopenia, thrombocytopenia – low red
      blood cells, white blood cells, platelets
Symptoms of Lupus
• Generalized symptoms:
     Unexplained fever
     Fatigue
     Weakness
     Achiness
     Headaches
     Dizziness
     Depression
• Less common symptoms:
     Ophthalmologic
     Gastrointestinal
Related Autoimmune Diseases
• Anti-Phospholipid Syndrome
• Sjogren’s Syndrome
• Raynaud’s Syndrome

• Associated disease -
     Fibromyalgia
How is Lupus Diagnosed?
• Combination of symptoms and tests
     No single test
• History and physical exam
• Laboratory tests
     blood, urine
• Biopsy
     Skin, Kidney
• Radiology
     X-Ray, CT, MRI


• Can take time to diagnose
                                      www.rheumatology.org
How is Lupus Diagnosed?
   • ANA – Anti-Nuclear Antibody – antibody to cells
              Virtually all with SLE (>98%)1
              ANA does NOT necessarily mean lupus
                 • False positive – up to 30% healthy people2


   • More specific antibodies –                                                              www.rheumatology.org


              Double Stranded DNA                                   Phospholipid Antibodies
              Smith/RNP                                             Sjogrens
   • Markers of inflammation and activity - ESR, CRP,
     complements (C3, C4)
1. Harrisons Internal Medicine, 18th ed. Longo et al. 2. Tan et al. Arthritis Rheum, 1997.
How is Lupus Diagnosed?
•       American College
        of Rheumatology
        Criteria
        ≥4 out of 11 criteria
         •   Lupus likely
        <4 criteria
         •   Undifferentiated
             syndrome?



                                 www.uptodateonline.com
What is the Course of Lupus?
•   Variable among patients
•   Most people with Lupus can lead full life
•   5 year survival rates are now over 95%
•   50% have milder symptoms - fatigue,
    joint pain, rash
              flare               relapse

                      remission
What is the Course of Lupus?
• More severe disease associated with:
     Heart, Lung, Brain, Kidney involvement
     Kidney Failure/Dialysis
     Infections


• Increased risk of heart disease
• Increased risk of cancer
How is Lupus Treated?

• There is no cure yet

• BUT…

• Many treatment options
• Can lead active, healthy lives
How is Lupus Treated?

• Goal:
      Reduce symptoms
      Prevent flares
      Prevent complications


• Treatment is tailored to individual
      Based on symptoms, concurrent conditions, lifestyle
      Treatment can be continuous or intermittent
How is Lupus Treated?
NSAIDs: Non-Steroidal Anti-Inflammatory Drugs
  • Over-the-counter or prescription
  • Treats:
       Joint pain
       Swelling
       Fever
  • Side effects:
       Stomach ulcers, kidney/liver problems,
        high blood pressure, heart disease
How is Lupus Treated?
          Immunosuppressive Therapy
• Suppresses immune system cells from
  forming and making antibodies to tissues
• Slow acting
• Oral, Injection
• Treats:
     Kidney, Heart, Lung, Brain
     Musculoskeletal
     Skin
     Blood
• Side effects:
     Infections, cancer risk, hair loss, nausea
How is Lupus Treated?
                Steroids / Prednisone
•   Anti-inflammatory / Immune suppressing
•   Works rapidly
•   Topical, Oral, or Injection
•   Treats:
       Kidney, Heart, Lung, Brain
       Musculoskeletal
       Skin
       Blood
• Side effects:
       Weight gain, mood change, infections, diabetes,
        high blood pressure, osteoporosis, cataracts
How is Lupus Treated?
         Plaquenil / Hydroxychloroquine
• Widely used medication
• Treats:
     Musculoskeletal
     Skin
     Fatigue
     Prevents flares
• Side effects:
     Stomach upset, retinal toxicity (very rare)
       • Screening eye exams
How is Lupus Treated?
          Other Immunosuppressives
•   Methotrexate
•   Imuran (Azathioprine)
•   Arava (Leflunomide)
•   Cellcept (Mycophenolate Mofetil)
•   Cytoxan (Cyclophosphamide)
•   Tacrolimus
•   Cyclosporine
•   Rituxan (Rituximab)
•   Benlysta (Belimumab)
How to Live Well with Lupus
• How to:
     Maintain control of disease
     Prevent flares
     Avoid complications
     Minimize risk of associated diseases
     Feel healthy
• To lead an active, high quality life
How to Live Well with Lupus?
Follow-up with Rheumatologist Regularly:
• 2-6 months for monitoring
• Even if feeling well
• Recognize symptoms of flares
• Get treated early
• Take medications consistently
How to Live Well with Lupus?
Follow-up with Your Doctors:
• Follow regularly for preventative care
     Internist/Primary care
     Gynecology
• Follow with Specialists
• Planned surgery
     Best when low activity
     Possible pre-medications
How to Live Well with Lupus?
Women’s Health:
• Pregnancy
     Can be associated with complications and flares
     Planned is ideal
     Monitored more closely
     May need to change medications

• Hormones – birth control pills, estrogen
     Safe if Lupus stable and no anti-phospholipid
      antibodies
     Possible increase in flares
     Non-estrogen pills, IUD
                                              Buyon et al.Annals Int Med, 2005.
How to Live Well with Lupus?

Reduce Risk of Infections:
• Lupus increases risk for infection
• Up to date with vaccines
     Influenza, Pneumovax, Shingles
• Wash hands frequently
• Stay away from people who are sick
• Get evaluated sooner rather than later
How to Live Well with Lupus?

Manage Fatigue:
• Get enough sleep
• Rest during the day
• Plan your time effectively
• Exercise
• Medications
How to Live Well with Lupus?
Healthy Lifestyle:
• Reduce sun exposure
     UV-B – sunlight or fluorescent light
     UV-A – sunlight, photocopier
     Use sunscreen >30 SPF, broad spectrum
     Avoid peak sun times
     Wear hats, protective clothing
How to Live Well with Lupus?
Healthy Lifestyle:
• Exercise
     Low-moderate activities
     Stretching, strengthening
• Don’t smoke
• Reduce stress
• Social support


                                  Costenbader et al. Arthritis Rheum, 2004.
How to Live Well with Lupus?
Healthy Lifestyle:
• Eat well balanced diet
  Fresh fruits/vegetables, fiber
  and grains, lean meats
  Vitamin D, Calcium
  ? - Omega-3 fatty acids, Anti-oxidants
  ? - Avoid certain foods
      • Alfalfa sprouts, Nightshade vegetables
      • Moderate alcohol
• Alternative treatments – not well studied
What’s New with Lupus?
• Benlysta / Belimumab
     Injection
     Treats:
       • Moderately active Lupus
     Side effects: infection, allergy, cancer


• In development…
What’s New with Lupus?
Treatment name                            Type                        Focus of Studies                                                       Company or Organization

Anti-interferon alpha therapies

                                          Anti-malarial /                                                                                    Assistance Publique - Hôpitaux de Paris &
Hydroxychloroquine                                                    Recent studies to measure the reduction of lupus flares
                                          TLR antagonist                                                                                     Sanofi-Synthelab

                                          Anti-Interferon-alpha /     Safety and efficacy studies to evaluate anti-inflammatory benefits
Rontalizumab (rhuMAb IFNalpha)*                                                                                                              Genentech
                                          Monoclonal antibody         in lupus patients

                                          Anti-Interferon-alpha /
Sifalimumab (Medi-545)                                                Studies to measure safety and tolerability in lupus patients           Medimmune, Inc.
                                          Monoclonal antibody

                                          Anti-Interferon-alpha /
AGS-009*                                                              Single dose escalation trial in SLE                                    Argos Therapeutics
                                          Monoclonal antibody

IFNα Kinoid                               Interferon-alpha vaccine    Dose escalation study in SLE                                           Neovacs

                                                                      Early studies evaluating anti-inflammatory effects (drug intended to
IMO-3100*                                 TLR7 and TLR9 blockers                                                                             Idera Pharmaceuticals
                                                                      block production of multiple pro-inflammatory cytokines)

                                                                                                                                             Dynavax Technologies
DV1179*                                   TLR7 and TLR9 inhibitor     Recent studies to measure the reduction of lupus flares                GlaxoSmithKline
                                                                                                                                             National Institutes of Health

Anti-Cytokine therapies

                                          Anti-interleukin-6          Studies to measure the safety and efficacy in patients with lupus
CNTO-136                                                                                                                                     Centocor, Inc.
                                          antibody                    nephritis (inflammation of the kidneys)

                                          Anti-interferon-gamma /     Study to evaluate the safety, tolerability, and clinical efficacy in
AMG811                                                                                                                                       Amgen
                                          monoclonal antibody         discoid lupus

Immunosuppressive therapies

                                          Immunosuppressant /
                                                                      Organ transplant rejection drug being studied for lupus & lupus
Mycophenolate mofetil (cellcept)          transplant anti-rejection                                                                          Genentech / Roche, multiple institutions
                                                                      nephritis
                                          drug

                                          Immunosuppressant /
                                                                      Organ transplant rejection drug being studied for lupus & lupus
Tacrolimus (sustained release capsules)   transplant anti-rejection                                                                          Multiple sites in Asia
                                                                      nephritis
                                          drug

                                                                                                                                             State University of New York-Upstate
Sirolimus                                 Immunosuppressant           Study in SLE
                                                                                                                                             Medical Center

                                                                                                                                                      www.lupusresearch.org
What’s New with Lupus?
B-Cell therapies

                                   B-cell inhibitor / recombinant
Atacicept (TACI-Ig)*                                                  Studies ongoing to pinpoint most effective dosing   EMD Serono
                                   fusion protein

                                   B-cell inhibitor / Monoclonal
Epratuzumab (anti-CD22)*                                              Study of the CD22 protein                           UCB and Immunomedics
                                   antibody

                                   B cell-inhibitor / Small Modular
SBI-087 (anti-CD20)                                                   Ascending single dose study                         Pfizer
                                   ImmunoPharmaceutical

Benlysta® (FDA approved drug)      B-cell inhibitor /
                                                                      Long-term safety and efficacy studies continue      GlaxoSmithKline Human Genome Sciences
(Belimumab/anti-BLys)*             monoclonal antibody

LY2127399                          B-cell inhibitor / monoclonal      Studies to measure the safety and tolerability in
                                                                                                                          Eli Lilly
(anti-BAFF monoclonal antibody)    antibody                           lupus patients

A623 (anti-BAFF)                   Anti-BAFF peptibody                Efficacy, safety and tolerability in SLE            Anthera


Bortezomib (Velcade)               Proteosome inhibitor               Proliferative lupus nephritis                       Weill Cornell Medical College

Immunomodulatory therapy

                                                                      Ongoing studies to measure efficacy; Lupuzor is
                                                                      thought to modulate, through a unique mechanism,
Lupuzor™ (CEP-33457)               CD4 T-Cell Modulator                                                                   Cephalon
                                                                      a specific subset of CD4 T cells which play a
                                                                      critical role in the physiopathology of lupus

                                   Inhibits B7-CD28 interaction,                                                          National Institute of Allergy and Infectious
Abatacept (CTLA4-lg)*,                                                Safety and efficacy studies to evaluate anti-
                                   rheumatoid                                                                             Diseases (NIAID) Immune Tolerance Network
Orencia®                                                              inflammatory benefits in lupus patients
                                   arthritis drug                                                                         Bristol Myers Squib

AMG557                             Anti-B7RP-1                        Active lupus nephritis                              Amgen


Laquinimod                         Immunomodulator                    Mild active SLE                                     Teva


Paquinimod                         Immunomodulator                    Maintenance therapy for lupus nephritis             Active Biotech Research


Leflunomide                        Immunomodulator                    Single ascending dose study                         RenJi Hospital



                                                                                                                                      www.lupusresearch.org
For more Information
• Lupus Foundation of America
     www.lupus.org


• National Institute of Arthritis and
  Musculoskeletal and Skin Diseases
     www.niams.nih.gov


• American College of Rheumatology
     www.rheumatology.org
Questions?
        Thank you!

    Lauren Kennish, MD
   Summit Medical Group
      Rheumatology
       908-273-4300

www.summitmedicalgroup.com
 Facebook/SummitMedicalNJ
 Twitter: @SummitMedicalNJ

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Lupus

  • 1. Living with Lupus Presented by: Lauren Kennish, MD Rheumatology August 22, 2012
  • 2. Lupus Outline • What is Lupus? • How Lupus is diagnosed • Symptoms of Lupus • Treatment options • Living with Lupus • New developments
  • 3. What is Lupus? • Lupus is an autoimmune disease • Autoimmune disease: Immune system incorrectly targets your own tissues and organs Antibodies form and attack cells Inflammation/Swelling Damage/Disease
  • 4. What is Lupus? • Systemic Lupus Erythematosus • Chronic condition • Can affect almost any organ  Brain •Skin  Heart •Musculoskeletal  Lung  Kidney •Blood • Variable in presentation and course Mild Severe
  • 5. What is Lupus? • 1-10 in 10,000 in US; 300,000-1 million affected • Diagnosed in ages 15-45 • Females (9x) > Males (1x) • More prevalent: African Americans, Hispanics, Asians > Caucasians Harrisons Internal Medicine, 18th ed. Longo et al. www.CDC.gov Bernatsky et al. Rheumatology, 2007.
  • 6. What Causes Lupus? • Unknown  Hereditary?  Environment? • Known Triggers:  Smoking  Sunlight  Hormones  Infection  Stress  Sulfa medications
  • 7. Symptoms of Lupus • Skin  Rash – • Malar (butterfly) • Discoid • Photosensitivity  Mouth/Nose sores  Hair loss • Musculoskeletal System  Arthritis- joint pain and swelling  Muscle weakness American College of Rheumatology www.rheumatology.org
  • 8. Symptoms of Lupus • Kidney  Lupus nephritis - change in urine, swelling, high blood pressure • Central Nervous System  Seizures, Psychosis  Headaches, neuropathy • Heart/Lungs  Serositis - chest pain, trouble breathing  Lung disease, heart valve disease • Blood www.rheumatology.org  Anemia, leukopenia, thrombocytopenia – low red blood cells, white blood cells, platelets
  • 9. Symptoms of Lupus • Generalized symptoms:  Unexplained fever  Fatigue  Weakness  Achiness  Headaches  Dizziness  Depression • Less common symptoms:  Ophthalmologic  Gastrointestinal
  • 10. Related Autoimmune Diseases • Anti-Phospholipid Syndrome • Sjogren’s Syndrome • Raynaud’s Syndrome • Associated disease -  Fibromyalgia
  • 11. How is Lupus Diagnosed? • Combination of symptoms and tests  No single test • History and physical exam • Laboratory tests  blood, urine • Biopsy  Skin, Kidney • Radiology  X-Ray, CT, MRI • Can take time to diagnose www.rheumatology.org
  • 12. How is Lupus Diagnosed? • ANA – Anti-Nuclear Antibody – antibody to cells  Virtually all with SLE (>98%)1  ANA does NOT necessarily mean lupus • False positive – up to 30% healthy people2 • More specific antibodies – www.rheumatology.org  Double Stranded DNA  Phospholipid Antibodies  Smith/RNP  Sjogrens • Markers of inflammation and activity - ESR, CRP, complements (C3, C4) 1. Harrisons Internal Medicine, 18th ed. Longo et al. 2. Tan et al. Arthritis Rheum, 1997.
  • 13. How is Lupus Diagnosed? • American College of Rheumatology Criteria  ≥4 out of 11 criteria • Lupus likely  <4 criteria • Undifferentiated syndrome? www.uptodateonline.com
  • 14. What is the Course of Lupus? • Variable among patients • Most people with Lupus can lead full life • 5 year survival rates are now over 95% • 50% have milder symptoms - fatigue, joint pain, rash flare relapse remission
  • 15. What is the Course of Lupus? • More severe disease associated with:  Heart, Lung, Brain, Kidney involvement  Kidney Failure/Dialysis  Infections • Increased risk of heart disease • Increased risk of cancer
  • 16. How is Lupus Treated? • There is no cure yet • BUT… • Many treatment options • Can lead active, healthy lives
  • 17. How is Lupus Treated? • Goal:  Reduce symptoms  Prevent flares  Prevent complications • Treatment is tailored to individual  Based on symptoms, concurrent conditions, lifestyle  Treatment can be continuous or intermittent
  • 18. How is Lupus Treated? NSAIDs: Non-Steroidal Anti-Inflammatory Drugs • Over-the-counter or prescription • Treats:  Joint pain  Swelling  Fever • Side effects:  Stomach ulcers, kidney/liver problems, high blood pressure, heart disease
  • 19. How is Lupus Treated? Immunosuppressive Therapy • Suppresses immune system cells from forming and making antibodies to tissues • Slow acting • Oral, Injection • Treats:  Kidney, Heart, Lung, Brain  Musculoskeletal  Skin  Blood • Side effects:  Infections, cancer risk, hair loss, nausea
  • 20. How is Lupus Treated? Steroids / Prednisone • Anti-inflammatory / Immune suppressing • Works rapidly • Topical, Oral, or Injection • Treats:  Kidney, Heart, Lung, Brain  Musculoskeletal  Skin  Blood • Side effects:  Weight gain, mood change, infections, diabetes, high blood pressure, osteoporosis, cataracts
  • 21. How is Lupus Treated? Plaquenil / Hydroxychloroquine • Widely used medication • Treats:  Musculoskeletal  Skin  Fatigue  Prevents flares • Side effects:  Stomach upset, retinal toxicity (very rare) • Screening eye exams
  • 22. How is Lupus Treated? Other Immunosuppressives • Methotrexate • Imuran (Azathioprine) • Arava (Leflunomide) • Cellcept (Mycophenolate Mofetil) • Cytoxan (Cyclophosphamide) • Tacrolimus • Cyclosporine • Rituxan (Rituximab) • Benlysta (Belimumab)
  • 23. How to Live Well with Lupus • How to:  Maintain control of disease  Prevent flares  Avoid complications  Minimize risk of associated diseases  Feel healthy • To lead an active, high quality life
  • 24. How to Live Well with Lupus? Follow-up with Rheumatologist Regularly: • 2-6 months for monitoring • Even if feeling well • Recognize symptoms of flares • Get treated early • Take medications consistently
  • 25. How to Live Well with Lupus? Follow-up with Your Doctors: • Follow regularly for preventative care  Internist/Primary care  Gynecology • Follow with Specialists • Planned surgery  Best when low activity  Possible pre-medications
  • 26. How to Live Well with Lupus? Women’s Health: • Pregnancy  Can be associated with complications and flares  Planned is ideal  Monitored more closely  May need to change medications • Hormones – birth control pills, estrogen  Safe if Lupus stable and no anti-phospholipid antibodies  Possible increase in flares  Non-estrogen pills, IUD Buyon et al.Annals Int Med, 2005.
  • 27. How to Live Well with Lupus? Reduce Risk of Infections: • Lupus increases risk for infection • Up to date with vaccines  Influenza, Pneumovax, Shingles • Wash hands frequently • Stay away from people who are sick • Get evaluated sooner rather than later
  • 28. How to Live Well with Lupus? Manage Fatigue: • Get enough sleep • Rest during the day • Plan your time effectively • Exercise • Medications
  • 29. How to Live Well with Lupus? Healthy Lifestyle: • Reduce sun exposure  UV-B – sunlight or fluorescent light  UV-A – sunlight, photocopier  Use sunscreen >30 SPF, broad spectrum  Avoid peak sun times  Wear hats, protective clothing
  • 30. How to Live Well with Lupus? Healthy Lifestyle: • Exercise  Low-moderate activities  Stretching, strengthening • Don’t smoke • Reduce stress • Social support Costenbader et al. Arthritis Rheum, 2004.
  • 31. How to Live Well with Lupus? Healthy Lifestyle: • Eat well balanced diet Fresh fruits/vegetables, fiber and grains, lean meats Vitamin D, Calcium ? - Omega-3 fatty acids, Anti-oxidants ? - Avoid certain foods • Alfalfa sprouts, Nightshade vegetables • Moderate alcohol • Alternative treatments – not well studied
  • 32. What’s New with Lupus? • Benlysta / Belimumab  Injection  Treats: • Moderately active Lupus  Side effects: infection, allergy, cancer • In development…
  • 33. What’s New with Lupus? Treatment name Type Focus of Studies Company or Organization Anti-interferon alpha therapies Anti-malarial / Assistance Publique - Hôpitaux de Paris & Hydroxychloroquine Recent studies to measure the reduction of lupus flares TLR antagonist Sanofi-Synthelab Anti-Interferon-alpha / Safety and efficacy studies to evaluate anti-inflammatory benefits Rontalizumab (rhuMAb IFNalpha)* Genentech Monoclonal antibody in lupus patients Anti-Interferon-alpha / Sifalimumab (Medi-545) Studies to measure safety and tolerability in lupus patients Medimmune, Inc. Monoclonal antibody Anti-Interferon-alpha / AGS-009* Single dose escalation trial in SLE Argos Therapeutics Monoclonal antibody IFNα Kinoid Interferon-alpha vaccine Dose escalation study in SLE Neovacs Early studies evaluating anti-inflammatory effects (drug intended to IMO-3100* TLR7 and TLR9 blockers Idera Pharmaceuticals block production of multiple pro-inflammatory cytokines) Dynavax Technologies DV1179* TLR7 and TLR9 inhibitor Recent studies to measure the reduction of lupus flares GlaxoSmithKline National Institutes of Health Anti-Cytokine therapies Anti-interleukin-6 Studies to measure the safety and efficacy in patients with lupus CNTO-136 Centocor, Inc. antibody nephritis (inflammation of the kidneys) Anti-interferon-gamma / Study to evaluate the safety, tolerability, and clinical efficacy in AMG811 Amgen monoclonal antibody discoid lupus Immunosuppressive therapies Immunosuppressant / Organ transplant rejection drug being studied for lupus & lupus Mycophenolate mofetil (cellcept) transplant anti-rejection Genentech / Roche, multiple institutions nephritis drug Immunosuppressant / Organ transplant rejection drug being studied for lupus & lupus Tacrolimus (sustained release capsules) transplant anti-rejection Multiple sites in Asia nephritis drug State University of New York-Upstate Sirolimus Immunosuppressant Study in SLE Medical Center www.lupusresearch.org
  • 34. What’s New with Lupus? B-Cell therapies B-cell inhibitor / recombinant Atacicept (TACI-Ig)* Studies ongoing to pinpoint most effective dosing EMD Serono fusion protein B-cell inhibitor / Monoclonal Epratuzumab (anti-CD22)* Study of the CD22 protein UCB and Immunomedics antibody B cell-inhibitor / Small Modular SBI-087 (anti-CD20) Ascending single dose study Pfizer ImmunoPharmaceutical Benlysta® (FDA approved drug) B-cell inhibitor / Long-term safety and efficacy studies continue GlaxoSmithKline Human Genome Sciences (Belimumab/anti-BLys)* monoclonal antibody LY2127399 B-cell inhibitor / monoclonal Studies to measure the safety and tolerability in Eli Lilly (anti-BAFF monoclonal antibody) antibody lupus patients A623 (anti-BAFF) Anti-BAFF peptibody Efficacy, safety and tolerability in SLE Anthera Bortezomib (Velcade) Proteosome inhibitor Proliferative lupus nephritis Weill Cornell Medical College Immunomodulatory therapy Ongoing studies to measure efficacy; Lupuzor is thought to modulate, through a unique mechanism, Lupuzor™ (CEP-33457) CD4 T-Cell Modulator Cephalon a specific subset of CD4 T cells which play a critical role in the physiopathology of lupus Inhibits B7-CD28 interaction, National Institute of Allergy and Infectious Abatacept (CTLA4-lg)*, Safety and efficacy studies to evaluate anti- rheumatoid Diseases (NIAID) Immune Tolerance Network Orencia® inflammatory benefits in lupus patients arthritis drug Bristol Myers Squib AMG557 Anti-B7RP-1 Active lupus nephritis Amgen Laquinimod Immunomodulator Mild active SLE Teva Paquinimod Immunomodulator Maintenance therapy for lupus nephritis Active Biotech Research Leflunomide Immunomodulator Single ascending dose study RenJi Hospital www.lupusresearch.org
  • 35. For more Information • Lupus Foundation of America  www.lupus.org • National Institute of Arthritis and Musculoskeletal and Skin Diseases  www.niams.nih.gov • American College of Rheumatology  www.rheumatology.org
  • 36. Questions? Thank you! Lauren Kennish, MD Summit Medical Group Rheumatology 908-273-4300 www.summitmedicalgroup.com Facebook/SummitMedicalNJ Twitter: @SummitMedicalNJ