Drug that restricts overactive immune systems could help treat lupus

By | December 21, 2019
A man works in a pharmaceutical factory. Visual monitoring of the quality of interferon production. Sterile hormone production line.

Interferon (pictured in bottles) is involved in regulating the body’s immune system

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A drug that stops the body’s overactive immune system could be key to treating lupus. This would be only the second new drug for the autoimmune condition in 60 years.

Around 5 million people around the world are affected by lupus, a condition that causes the body’s immune system to attack healthy organs and results in skin rashes, joint and muscle pain, fatigue and early death.

There is no cure, and doctors often rely on therapies from the 1950s to treat symptoms, says Eric Morand of Monash University, Australia. One in 10 people diagnosed with the disease, typically young women, will die within a decade after diagnosis.

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A growing body of evidence suggests that lupus is linked to producing too many molecules called type 1 interferons, which are involved in regulating the body’s immune system. This prompted Morand and his colleagues to study the effects of anifrolumab, a drug that binds to type 1 interferon receptors and stops the molecule from overstimulating the immune system.

They randomly assigned 362 people with moderate to severe symptoms of lupus to receive a 300-milligram injection of either a placebo or anifrolumab every four weeks for almost a year.

The benchmark for success was if all of a participant’s organs that displayed signs of the disease at the beginning of the study improved and there were no flare-ups over the year. They found that 48 per cent of participants taking the drug achieved this, compared with 32 per cent taking the placebo.

In addition, 52 per cent of those who were taking steroids for the condition were able to reduce the dose, compared with 30 per cent in the control group. This is important because the steroids commonly have side effects such as weight gain, osteoporosis, skin fragility and infections.

“In lupus patients there is an additional complication,” says Morand. “With long-term use, the harmful effects of lupus itself appear to be amplified by exposure to steroids – so it’s a real double-edged sword.”

Sean O’Neill at the University of Sydney in Australia says the findings are a “great achievement for a disease that desperately needs some progress”.

However, there are still negative side-effects of the anifrolumab to overcome. The drug was associated with an increase in upper respiratory tract infections, such as the common cold, and herpes zoster, also known as shingles. One person taking the drug died of pneumonia.

Interferon’s role in the immune system is chiefly to defend against viruses, so these effects are expected from a drug that blocks the protein from working, says Morand.

They hope that vaccinating people against herpes zoster, for example, will help reduce these risks.

Journal reference: New England Journal of Medicine, DOI: 10.1056/NEJMoa1912196

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