Joan T. Merrill, a leading figure in lupus research at the Oklahoma Medical Research Foundation, shares insights on her groundbreaking SLEek Study. She discusses the efficacy and safety of upadacitinib and elsubrutinib for systemic lupus erythematosus. The conversation delves into innovative trial designs, challenges in lupus treatment trials during the pandemic, and personal anecdotes from her unique journey into rheumatology. Merrill emphasizes how patient experiences shape research and highlights the promising outcomes of recent clinical trials.
The SLEek Study demonstrated that combining U-Petacitinib and elsubrutinib potentially enhances treatment efficacy and reduces corticosteroid use in lupus patients.
Rigorous patient selection and ongoing safety monitoring were crucial for ensuring reliable outcomes and managing risks during the trial execution.
Deep dives
Overview of the Lupus Trial
A recent Phase II randomized controlled trial focused on the efficacy and safety of U-Petacitinib and L-Subrutinib, either alone or in combination, for patients with systemic lupus erythematosus. This study emerged from a need for more effective treatments for lupus, as challenges in trial design have historically led to disappointing results. The trial also showcased the use of ABBV599, a unique combination of the two agents, which is believed to potentially enhance treatment efficacy while addressing concerns about toxicities. The innovative approach of investigating drug combinations aims to improve trial efficiency and broaden understanding of pharmacokinetics in lupus treatment.
Study Design and Patient Selection
The trial was structured to evaluate multiple dosing and different combinations of the drugs involved, leading to the creation of five treatment groups. Patients eligible for the trial had to meet specific criteria, including active lupus symptoms and stable background medications, with careful consideration of exclusion criteria to mitigate risks from comorbid conditions. An adjudication committee ensured that only patients with confirmed lupus and appropriate disease activity were included in the study, enhancing the reliability of the results. This rigorous patient selection was essential in balancing the characteristics across treatment arms and ensuring the validity of the outcomes.
Interim Analysis and Efficacy Results
A planned unblinded interim analysis was conducted to assess the efficacy of the various dosing groups once half of the patients completed the 24-week mark or dropped out. The analysis revealed that some dosing groups were ineffective and led to the discontinuation of those arms while allowing effective treatments to proceed through the trial. By week 48, significant efficacy was observed in treatment arms using U-Petacitinib alone and the combination therapy, with primary endpoints achieved indicating improvements in disease activity and corticosteroid reduction. These early insights suggested that combining therapies could offer better outcomes for patients struggling with lupus.
Safety and Challenges Faced
The safety profile of the trial was monitored closely, particularly during the pandemic which presented unique challenges in patient enrollment and trial execution. Although two patients experienced COVID-19-related deaths, the overall safety data indicated no new significant risks associated with the treatments. Minor infections were observed, but the rate of serious adverse events was actually lower in the combination treatment group compared to others. The experience highlighted the importance of ongoing safety analysis and adaptability in conducting clinical trials, particularly in the context of external challenges such as infectious diseases.
This week, our next guest, ACR Master Dr. Joan T. Merrill, joins us to discuss her latest study which endeavored to evaluate the efficacy and safety of upadacitinib and elsubrutinib in those with systemic lupus erythematosus (SLE). Join us for an in-depth analysis of the SLEek Study, its findings regarding the efficacy of these medications and Dr. Merrill’s conclusions.
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