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- W4386278301 abstract "<h3></h3> Systemic lupus erythematosus (SLE) is a heterogeneous disease characterised by abnormalities in cellular and humoral immunity. There is evidence that abnormalities of B lineage cells (B and plasma cells) and imprints of type I interferon are key drivers in this disease. However, these findings are not found uniquely in each SLE patient which has implications for translational research: Delineation of molecular SLE endotypes have been identified that may allow better prediction of treatment response. Recent discoveries of gain-of-function mutations in toll-like TLR7 signalling in certain patients suffering from monogenetic SLE indicate the role of this pathway as potential treatment target.<sup>1</sup> Targeting enhanced cytokine signalling, in particular Jak/STAT continuous to be of interest as recent data of upadacitinib<sup>2</sup> and deucravacitinib.<sup>3</sup> were promising, although development of baricitinib<sup>4 5</sup> has not been continued. Clinical experiences with belimumab provide evidence that indirectly blocking B cell survival can change the clinical course of the disease, including prevention of damage accrual. Advanced B cell targeting following the concepts of deeper tissue depletion overcoming the status of anergic B cells<sup>6</sup> and co-targeting plasma cells has been studied recently. These include more profound targeting by second generation anti-CD20 modalities (obinutuzumab),<sup>7</sup> CD19-CART<sup>8</sup> or employing other immune targets, such as CD38 (daratumumab),<sup>9</sup> BAFFR (ianalumab)<sup>10</sup> or the use of immune proteasome inhibition (zetomipzomib).<sup>11</sup> As more defined immune abnormalities in SLE may be identified as targets for treatment, use of bispecific antibodies<sup>12</sup> may hold promise to improve selective immune therapy with at least similar or even better efficacy/safety compared to current strategies. <h3>References</h3> Brown GJ, <i>et al</i>. TLR7 gain-of-function genetic variation causes human lupus. <i>Nature</i>. 2022 May;<b>605</b>(7909):349–356. doi: 10.1038/s41586-022-04642-z. Epub 2022 Apr 27. Merrill JT, <i>et al</i>. Efficacy and safety of ABBV-599 high dose (elsubrutinib 60 mg and upadacitinib 30 mg) and upadacitinib monotherapy for the treatment of systemic lupus erythematosus: a phase 2, double-blind, placebo-controlled trial. <i>Ann Rheum Dis.</i> 2023;<b>82</b>:91–92. OP0139. Morand E, <i>et al</i>. Deucravacitinib, a tyrosine kinase 2 inhibitor, in systemic lupus erythematosus: a phase II, randomized, double-blind, placebo-controlled trial. <i>Arthritis Rheumatol</i>. 2023 Feb;<b>75</b>(2):242–252. doi: 10.1002/art.42391. Epub 2022 Nov 11. Petri M, <i>et al</i>. Baricitinib for systemic lupus erythematosus: a double-blind, randomised, placebo-controlled, phase 3 trial (SLE-BRAVE-II). <i>Lancet</i>. 2023 Mar 25;<b>401</b>(10381):1011–1019. doi: 10.1016/S0140-6736(22)02546-6. Epub 2023 Feb 24 Morand EF, <i>et al</i>. Baricitinib for systemic lupus erythematosus: a double-blind, randomised, placebo-controlled, phase 3 trial (SLE-BRAVE-I). <i>Lancet</i>. 2023 Mar 25;<b>401</b>(10381):1001–1010. doi: 10.1016/S0140-6736(22)02607-1. Epub 2023 Feb 24. Weißenberg SY, <i>et al</i>. Identification and characterization of post-activated B cells in systemic autoimmune diseases. <i>Front Immunol</i>. 2019 Sep 24;<b>10</b>:2136. doi: 10.3389/fimmu.2019.02136. Furie RA, <i>et al</i>. B-cell depletion with obinutuzumab for the treatment of proliferative lupus nephritis: a randomised, double-blind, placebo-controlled trial. <i>Ann Rheum Dis</i>. 2022 Jan;<b>81</b>(1):100–107. doi: 10.1136/annrheumdis-2021-220920. Epub 2021 Oct 6. Mackensen A, <i>et al</i>. Anti-CD19 CAR T cell therapy for refractory systemic lupus erythematosus. <i>Nat Med.</i> 2022 Oct;<b>28</b>(10):2124–2132. doi: 10.1038/s41591-022-02017-5. Epub 2022 Sep 15. Erratum in: <i>Nat Med</i>. 2022 Nov 3. Ostendorf L, <i>et al</i>. Targeting CD38 with daratumumab in refractory systemic lupus erythematosus. <i>N Engl J Med</i>. 2020 Sep 17;<b>383</b>(12):1149–1155. doi: 10.1056/NEJMoa2023325. Cortés-Hernández J, <i>et al.</i> Safety and efficacy of subcutaneous (S.C.) dose ianalumab (VAY736; anti-BAFFR mAb) administered monthly over 28 weeks in patients with systemic lupus erythematosus (SLE). <i>Ann Rheum Dis</i>. 2023;<b>82</b>:275–276. POS0120. Saxena A, <i>et al.</i> Zetomipzomib (KZR-616) treatment results in clinically meaningful renal responses in patients with lupus nephritis. <i>Ann Rheum Dis</i>; 2023;<b>82</b>:891–892. POS1128. Dang VD, <i>et al</i>. B- and plasma cell subsets in autoimmune diseases: translational perspectives. <i>J Invest Dermatol</i>. 2022 Mar;<b>142</b>(3 Pt B):811–822. doi: 10.1016/j.jid.2021.05.038. Epub 2021 Dec 24. <h3>Learning Objectives</h3> Discuss the translational concepts of the SLE key signatures: type I IFN (convergence of various activated pathways) and B lineage abnormalities (plasmablasts including CD19-CXCR5- pre-plasmablasts, anergic B cells) Explain the impact of targeting type IFN abnormalities by blocking Jak/STAT and TL/signaling Discuss new concepts with deeper depletion of tissue-resident B cells and partial targeting of bone marrow plasma cells Develop the concept that bispecific antibodies may have value in treating SLE" @default.
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- W4386278301 date "2023-08-30" @default.
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- W4386278301 title "31 Other targets: expectations from research on pathogenic mechanisms" @default.
- W4386278301 doi "https://doi.org/10.1136/lupus-2023-la.31" @default.
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