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Rheum Dis Clin North Am [journal]
- Systemic lupus erythematosus. [Editorial]
- Rheum Dis Clin North Am 2014 Aug; 40(3):xiii-xiv.
- Foreword. [Editorial]
- Rheum Dis Clin North Am 2014 Aug; 40(3):xi.
- Improving Participation in Clinical Trials of Novel Therapies: Going Back to Basics. [REVIEW]
- Rheum Dis Clin North Am 2014 Aug; 40(3):553-559.
Clinical trials in many diseases are experiencing more difficulties in achieving sufficient or timely enrollment of participants; anecdotal reports from trials of novel therapies for systemic lupus erythematosus (SLE) seem to be facing the same challenges. General factors associated with this trend include the growth of the contract research industry, increasing oversight, and high-profile accounts of scientific misconduct and fraud in research. Complicated protocols that increase participant burden, overly restrictive entry criteria, the fear of an SLE flare may also affect enrollment in SLE trials.
- The Kidney Biopsy in Lupus Nephritis: Is It Still Relevant? [REVIEW]
- Rheum Dis Clin North Am 2014 Aug; 40(3):537-552.
The kidney biopsy is the standard of care for diagnosis of lupus nephritis and remains necessary to ensure accurate diagnosis and guide treatment. Repeat biopsy should be considered when therapy modifications are necessary, as in cases with incomplete or no response, or when stopping therapy for those in remission. There are several promising biomarkers of kidney disorders; however, these markers need to be validated in a prospective clinical trial before being applied clinically. Molecular analysis may provide the information presently lacking from current evaluation of kidney disorders and may better inform on prognosis and treatment considerations.
- Recent Clinical Trials in Lupus Nephritis. [REVIEW]
- Rheum Dis Clin North Am 2014 Aug; 40(3):519-535.
Recent clinical trials have provided evidence for the efficacy of low-dose intravenous cyclophosphamide and mycophenolate mofetil as induction treatment for patients with proliferative lupus nephritis in comparative trials with standard-dose intravenous cyclophosphamide. Trials of maintenance treatments have had more variable results, but suggest that the efficacy of mycophenolate mofetil may be similar to that of quarterly standard-dose intravenous cyclophosphamide and somewhat more efficacious than azathioprine. Differential responses to mycophenolate mofetil based on ethnicity suggest that it may be more effective in black and Hispanic patients. Rituximab was not efficacious as an adjunct to induction treatment with mycophenolate mofetil.
- Post-marketing Experiences with Belimumab in the Treatment of SLE Patients. [REVIEW]
- Rheum Dis Clin North Am 2014 Aug; 40(3):507-517.
Belimumab (Benlysta) is a human recombinant monoclonal antibody that targets and inhibits soluble B-lymphocyte stimulator, also known as B-cell activating factor, a proliferation and survival factor for B cells. The published clinical trials data showed that in patients with active systemic lupus erythematosus (SLE), belimumab effectively reduced peripheral B-cell levels and improved disease activity. This article reviews the belimumab clinical trials and the post-marketing experience with belimumab in the treatment of those lupus patients with persistent active disease despite current standard of care (SOC) therapy.
- Systemic Lupus Erythematosus and Malignancies: A Review Article. [REVIEW]
- Rheum Dis Clin North Am 2014 Aug; 40(3):497-506.
The systemic lupus erythematosus (SLE) population has a unique cancer risk profile. This article presents the most recent data on risk of cancer in lupus and discusses possible contributing factors. The risk of lymphoma is particularly increased in SLE and may be mediated by immunosuppressive medication. Lung cancer risk is also increased in SLE. There is a high rate of cervical dysplasia in women with SLE. A similar pathophysiology could be responsible for the trend seen in vulvovaginal and hepatic carcinomas. There is a decreased risk in SLE for some hormone-sensitive cancers, but the cause of this remains unclear.
- Pathogenesis and Treatment of Atherosclerosis in Lupus. [REVIEW]
- Rheum Dis Clin North Am 2014 Aug; 40(3):475-495.
The prevalence of atherosclerosis (ATH) is higher in patients with systemic lupus erythematosus (SLE) and occurs at an earlier age. The lupus-related factors that account for this increased risk are likely numerous and related to the factors described in this article. Identifying of at-risk subjects and increasing the understanding of pathogenesis of ATH in SLE is critical for improving the quality of care and improving mortality in this vulnerable population.
- The Immunopathology of Cutaneous Lupus Erythematosus. [REVIEW]
- Rheum Dis Clin North Am 2014 Aug; 40(3):455-474.
Systemic lupus erythematosus (SLE) is an autoimmune disease that is characterized by the development of autoantibodies and immunologic attack of different organ systems, including the skin. This review aims to provide an overview of some of the pathogenic processes that may be important in the development of SLE, specifically cutaneous lupus erythematosus, and then illustrates how therapies might be tailored to modify these processes and treat disease.
- Impact of Race and Ethnicity in the Course and Outcome of Systemic Lupus Erythematosus. [REVIEW]
- Rheum Dis Clin North Am 2014 Aug; 40(3):433-454.
Genetic factors seem to play a more important role early in the course of systemic lupus erythematosus (SLE), whereas nongenetic factors seem to play a more important role over the course of the disease. SLE is more frequent with less favorable outcomes in nonwhite populations. To overcome these differences and reduce the immediate-term, mediate-term, and long-term impact of SLE among disadvantaged populations, it is essential to increase disease awareness, to improve access to health care and to provide care to these patients in a consistent manner regardless of the severity of their disease.