Systemic Lupus Erythematosus: Current Research and Latest Info for Compounding Pharmacists
Trying to find targeted treatments for systemic lupus erythematosus (SLE) is like assembling a 500-piece jigsaw puzzle that has no artwork provided for clues. But with perseverance, a few random pieces can begin to connect and the solution gets a little closer. Several groups of researchers have done exactly that in recent months: put together physiological pieces that reveal more about what happens in patients with SLE at the cellular and genetic level. In the process, they’ve created a new focus for future treatments, slowly bringing the bigger picture—SLE’s causes and personalized treatment—closer to reality.
Recent Lupus Research Reveals New Treatment Targets
New treatments for lupus are long overdue. One drug producing solid results in Phase II trials—anifrolumab—is one of the first new treatments in 60 years, according to AstraZeneca. The drugs currently in clinical trials target various aspects of the immune response and inflammation, such as T-cells, type I interferon and interferon-alpha. While pharmaceuticals in the pipeline now may improve lupus symptoms better than existing meds, the future lies in uncovering the precise cellular mechanisms driving the disease process. That’s where several new studies stand to make a difference.
- Researchers at Beth Israel Deaconess Medical Center discovered high levels of the SHP2 enzyme in blood samples taken from patients with lupus, as well as in mouse models of SLE. Elevated levels of SHP2 lead to cytokine production and subsequent lupus-related inflammation. They also found that inhibiting SHP2 reduced the number of double-negative T cells and decreased production of cytokines involved in SLE-associated organ damage. All of their results suggest that targeting SHP2 activity is a promising direction for future treatments.1
- Another cellular discovery occurred at the Baylor Institute for Immunology Research. In April 2016, researchers found that neutrophils in SLE patients release oxidized DNA. Neutrophils accumulate oxidized DNA within their mitochondria, but under normal conditions, the oxidized DNA is disassembled and degraded. This disassembly process is impaired in patients with SLE, so the oxidized DNA eventually stimulates interferon production and an unwanted immune response. Future treatments that target this pathway may improve lupus symptoms.2
- Two additional studies have assembled pieces of the genetic puzzle that will ultimately lead to personalized lupus treatments. In March 2016, Cell reported that 924 blood samples from 158 pediatric patients with lupus had been studied. As researchers measured gene expression activity, they were able to classify all of the patients into seven groups. It turned out that each group actually shared similar molecular disease structure at the time of disease flares and remissions.3
- A study presented at the June 2016 meeting of the European League Against Rheumatism reported a distinct link between the vascular endothelial growth factor (VEGF) genetic pathway and the development of mouth ulcers in SLE patients. The researchers began by genotyping 482 patients. Eleven relevant SLE phenotypes were identified, which were tested against more than 700 reference genetic pathways. After finding two genetic pathways significantly associated with mouth ulcers, the researchers tested a second independent group of 425 lupus patients. That’s when the association between mouth ulcers and the VEGF pathway way confirmed. This piece of the puzzle helps lay the groundwork for defining the genetic basis of SLE’s different clinical presentations.4
Systemic Lupus Erythematosus Overview and Implications for Compounding
The complex nature of lupus makes it vital to stay up-to-date with the latest information. With the number of medical studies published every year, keeping up is a challenge, but lupus patients are often desperate for any bit of info that can help them manage symptoms, maintain quality of life or even offer the hope of future treatments. For example, air pollution was recently identified as an exacerbating factor in children with lupus.5 Many patients may benefit from staying indoors on days when the air pollution index is high. At the very least, they can experiment to see if it makes a difference.
While the cause remains unknown, many genes have been linked to the disease.6 Experts believe that varying combinations of genetic and environmental factors lead to SLE’s diverse clinical manifestations, which include cutaneous symptoms, hematologic symptoms and neuropsychiatric disorders. SLE is often identified by the classic triad of fever, joint pain and a rash, but since it can affect almost any organ and body system, diverse symptoms appear that are specific to the underlying pathophysiology. It’s also good to know that lupus primarily affects women of childbearing age.
This disease is one that practically begs for the treatment solutions that compounding pharmacists can offer. Depending on the individual, treatment incorporates any combination of non-pharmacologic options—diet, avoiding sunlight, psychological support and exercise—as well as a host of pharmacologic treatments. Antimalarials, NSAIDs, disease-modifying antirheumatic drugs (DMARDS), rheumatologics and corticosteroids are all on the list of options. Physicians must experiment with medications and dosages from various groups of pharmaceuticals to find the most effective treatment for each patient. In addition to combining multiple pharmaceuticals and formulating the dose, compounding pharmacists offer the best support for:
- Topical treatments – Patients with lupus commonly have skin rashes that benefit from topical steroids mixed in an emollient base known to maintain the skin barrier. They often rely on topical NSAIDs or natural products like capsaicin or glucosamine and chondroitin to relieve muscle and joint pain.
- Fighting fatigue – Many of those with SLE experience fatigue. In fact, it’s often described as debilitating and is one of the symptoms most likely to interfere with everyday activities. Inability to sleep and less physical activity are both associated with lupus-related fatigue.7 Topical treatments that fight pain can boost activity. Compounding pharmacists can also help with sleep by talking to patients about formulating natural ingredients like melatonin.
Proactive Outreach and Education Leads to Solutions
Keep in mind that lupus patients often continue to suffer from symptoms even with treatment. Many might believe they’re getting the best treatment possible, and that may be true. On the other hand, there are many aspects to consider. They may benefit from adjustments in their regimen, including individualized dosing and topical remedies. Compounding pharmacists who reach out and talk about options help lead to better solutions.
Pharmaceutica North America provides high-quality bulk APIs, prescription diclofenac and OTC supplements that can be compounded to treat your patients with lupus. Contact us today to talk about how we can support the needs of your pharmacy.
- “Inhibition of SHP2 Ameliorates the Pathogenesis of Systemic Lupus Erythematosus,” May 2016, https://www.jci.org/articles/view/87037 ↩
- “Oxidized Mitochondrial Nucleoids Released by Neutrophils Drive Type I Interferon Production in Human Lupus,” April 2016, http://jem.rupress.org/content/213/5/697 ↩
- “Personalized Immunomonitoring Uncovers Molecular Networks That Stratify Lupus Patients,” April 2016, http://www.ncbi.nlm.nih.gov/pubmed/27040498 ↩
- “Genetic Clue to Development of Mouth Ulcers in Lupus,” June 2016, https://www.sciencedaily.com/releases/2016/06/160610173520.htm ↩
- “Air Pollution Exposure May Worsen Lupus in Children,” June 2016, https://www.sciencedaily.com/releases/2016/06/160609115429.htm ↩
- “A Review of Systemic Lupus Erythematosus,” June 2016, https://www.uspharmacist.com/article/a-review-of-systemic-lupus-erythematosus ↩
- “Fifteen Questions – Fatigue and Lupus,” 2016, http://www.lupus.org/resources/15-questions-fatigue-and-lupus ↩