SLE is not a one-size-fits-all disease

Abstract

In this Viewpoint we discuss how experimental medicine applied in the setting of clinical trials can address unmet need in the prototypic autoimmune disease systemic lupus erythematosus (SLE) to improve outcomes for patients.

Figure 1.

Clinical trials provide a unique substrate to understand pathogenesis and identify biomarkers to targeted therapies in SLE which can be used to stratify patients. Conventional approaches to understanding disease pathogenesis and heterogeneity in SLE focus on cross-sectional and longitudinal studies. But with randomized clinical trials testing targeted therapies, the effects of treatment are more rigorously controlled not only through comparative longitudinal analysis of the active versus placebo arm from baseline and several timepoints thereafter but also with the increasing practice of tapering concomitant immune suppressive therapies. Profiling patients within a clinical trial can deconvolute disease heterogeneity in SLE and reveal a disease endotype that responds to the targeted therapy under evaluation. The identification of a biomarker for that endotype enables stratification in a subsequent clinical trial. Eventually this approach applied to several different treatments could potentially provide therapeutic strategies for a spectrum of distinct lupus endotypes.