SLE treatment with type 1 interferon antagonists in the era of COVID-19

Kimberly Legault, MD, MSc, is an associate professor of medicine in the Division of Rheumatology at McMaster University.

In view of recent clinical trials, which patients with systemic lupus erythematosus (SLE) may benefit most from treatment with a type 1 interferon antagonist? Is the safety profile of this therapy acceptable today, in the era of the mutating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic?

I think that the patients that would be most benefited by anti-interferon therapy would be those who were found in the clinical trials to have efficacy with this therapy. Those tended to be the patients who were seropositive, so who had evidence of recent antinuclear antibody (ANA) positivity and double-stranded DNA elevations, for example; those who had more moderate disease severity [without] the more severe manifestations, because in the studies for those therapies patients with significant renal and neuropsychiatric [manifestations] were excluded.

I think we’re looking at the patients [with] a moderate severity [SLE], and typically the patients in the study had had prior immunomodulatory agents. These therapies are often more expensive, so we’re very frequently going to be using them in the patients who have tried the other therapies and these therapies have failed them, especially those who had active disease of moderate severity despite the use of antimalarials as well as steroids, and [we would] try to reduce the dose of glucocorticoids in those on unacceptably high doses.

I think that the safety profile has been essentially comparable to a lot of our other biologic therapies. Of course, with SARS-CoV-2, we always worry about the possibility of more severe disease. I definitely think that is something that should be studied and patients should be aware that these are immunomodulatory agents that can put them at higher risk. However, of course, severe lupus can lead to severe manifestations and most of the time we have continued to use our biologic therapies despite the pandemics. So I think that they will likely still be acceptable for use but of course I think that should be studied to be certain.