When an individual has an autoimmune disease, a person’s immune system attacks its own body as if it were a foreign pathogen. These diseases are complex and difficult to understand, as the mechanisms underlying them are not always clear. Oftentimes autoimmunity involves the interplay of genetics, stress, and environmental factors, consequently eliciting an autoimmune response within the body. Likewise, these conditions are often hard to treat, and more research is needed within the field. This article will discuss recent developments in research and therapy within the field of rheumatology.
Precision medicine
Unlike many other diseases, autoimmune diseases do not always present uniformly, as symptoms differ widely across different patients. Likewise, a treatment that is successful for one person may not always be successful for the next. Andrew Wang, MD, PhD, an assistant professor of rheumatology and immunobiology, recognizes this in his own practice. To address these disparities, he utilizes what is known as precision medicine1.
Precision medicine involves individualizing treatment plans to the symptoms and characteristics of each patient. In precision medicine, a physician would consider the multifactorial causes of autoimmunity, known as “predictive factors”, such as one’s genes, environment, and lifestyle. Using these predictive factors, physicians can use certain drugs to target the specific signaling pathways affecting a patient. Doing such could optimize drug efficacy and potentially decrease the risk of adverse events2.
National Institutes of Health Research Support
Although various treatment options exist for patients, these treatments are not always effective, nor do they always have favorable safety profiles. Thus, there is an immense need for more research in the field of rheumatology in order to better understand these diseases and better treat them. The National Institutes of Health (NIH) has done extensive research within the field, but a congressionally mandated report indicates that an adequately funded office would provide better coordination of research.
The committee suggested focusing on 11 specific autoimmune diseases, including systemic lupus erythematosus (SLE), rheumatoid arthritis, inflammatory bowel disease (IBD), and Sjögren’s disease, amongst others. In implementing such an office, strategic goals would include:
- Evaluating the heterogeneity of autoimmune diseases to identify both commonalities and disease-specific mechanisms
- Identifying biomarkers (e.g., autoantibodies) that can assist in the diagnosis and prognosis of autoimmune conditions
- Understanding how social determinants of health and environmental exposures contribute to autoimmune conditions
- Assessing rare autoimmune diseases and creating relevant animal models
- Understanding the mechanisms underlying the genetic component of autoimmunity and associated gene-environment interactions
- Evaluating how co-existing morbidities and other autoimmune diseases affect autoimmunity and treatment3
Recent drug approvals
In addition to developments in research and treatment strategies, many drugs have hit the market in recent years aimed at treating autoimmune conditions. Notable examples include:
- Saphnelo (anifrolumab-fnia) - AstraZeneca’s type I interferon receptor antibody drug was approved in the US in 2021. It is indicated for individuals with moderate to severe systemic lupus erythematosus (SLE) that are also getting standard therapy. As a first-in-class medicine, it is the only new drug in the past 10 years for individuals with SLE4.
- Vyvgart (efgartigimod) - Vyvgart was approved in December 2021 in the US for the treatment of generalized myasthenia gravis (gMG) in patients that are positive for the anti-acetylcholine receptor (AChR) antibody. Vyvgart is a first-in-class medication and offers a treatment option for gMG patients who have a significant unmet medical need5.
- Olumiant (baricitinib) - Olumiant is indicated for those with moderate-to-severe rheumatoid arthritis as either a third- or fourth-line therapy. It is for individuals that have failed therapy with an older disease modifying therapy (DMT) such as a TNF inhibitor or methotrexate6.
References
- Untangling the web of autoimmune diseases. (n.d.). Retrieved May 24, 2022.
- The growing role of precision medicine for the treatment of autoimmune diseases; results of a systematic review of literature and Experts’ Consensus. (2021). Autoimmunity Reviews, 20(2), 102738.
- NIH Should Create an Office of Autoimmune Disease Research, Says New Report. Retrieved May 24, 2022.
- Saphnelo (Anifrolumab) approved in the US for moderate to severe systemic lupus erythematosus. (n.d.). Retrieved May 24, 2022.
- Commissioner, O. (2021, December 17). FDA approves new treatment for myasthenia gravis. FDA.
- Loria, K. (2019). The latest autoimmune disease treatment advances. MHE Publication, 29(7).