The monoclonal antibody belimumab (Benlysta) is on the road to becoming the first new treatment for lupus approved in 50 years. It inhibits the activity of the B-lymphocyte stimulator, BLyS. An advisory panel for the United States Food and Drug Administration recommended approval on Tuesday, November 16, 2010. Approval may come as early as December 9.
Lupus is one of the most complicated of autoimmune diseases, with symptoms that vary widely. Many different organs and tissues can be damaged, including the joints, skin, blood cells, kidneys, heart, and lungs. According to the Mayo Clinic web site, standard drug therapy includes anti-inflammatories plus the following drugs:
1. Anti-malarials (hydroxychloroquine is the most common in this class)
2. Cyclophosphamide
3. Azothioprine
4. Gamma globulin
5. Methotrexate
6. Mycophenolate
Other treatments in clinical trials include:
1. Stem cell transplants
2. DHEA, the dietary supplement
3. Rituximab. This is already in use for rheumatoid arthritis and other conditions
In addition, the current medical literature describes research into the roles of four cytokines:
1. Interferon alpha. This molecule is produced by many cell types in response to viral infection. There are many lines of indirect evidence that suggest it may be overproduced in lupus.
2. Interleukin-21. Excessive production has been associated with the development of multiple autoimmune diseases.
3. Interleukin-2. Too little of this molecule could be a factor in the development of lupus.
4. Tumor necrosis factor alpha. It has been proposed that this molecule regulates the balance of T cells. The authors of Reference 3 suggest that anti-TNF drugs may be beneficial if it is administered in the optimum timing of the lupus episode cycle.
There are many drugs either available or under development to counteract the effects of various pro-inflammatory cytokines. Would it make sense to take any or all of them? Check with your doctor to see what the latest results mean to you. It remains a challenge to understand how to get the entire system back in balance.
References:
1. Benlysta:
http://www.washingtonpost.com/wp-dyn/content/article/2010/11/16/AR2010111607455.html
http://www.medpagetoday.com/Rheumatology/Lupus/23324
2. Niewold TB et al, “Interferon alpha in systemic lupus erythematosus”, J Biomed Biotechnol. 2010: 948364.
3. Sarra M et al, “Interleukin-21: a new mediator of inflammation in systemic lupus erythematosus”, J Biomed Biotechnol. 2010: 294582.
4. Ahu LJ et al, “Anti-TNF-alpha therapies in systemic lupus erythematosus”, J Biomed Biotechnol. 2010: 465898.
5. Lieberman LA et al, “The IL-2 defect in systemic lupus erythematosus disease has an expansive effect on host immunity”, J Biomed Biotechnol. 2010: 740619.
6. Rituximab:
http://www.rituxan.com/
7. More information online:
http://www.mayoclinic.com/health/lupus/DS00115
Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.