Lupus Doctor

H. Michael Belmont, MD - Professor of Medicine NYU School of Medicine -Director of Lupus Clinic Bellevue Hospital, Rheumatologist

[Lupus Doctor @LupusMD]

@AtlantaFalcons @Bijan5Robinson Impressive run

[Lupus Doctor @LupusMD]

Complement inhibitors, anti-C5 Eculizumab and ravulizumab, approved for PNH,aHUS, AQ4+NMOSD,& generalized Myasthenia Gravis. Sutimlimab, anti-C1s, approved for cold agglutinin disease. Predict future with complement inhibitors approved for lupus nephritis https://t.co/UDIt1y1axk

[Lupus Doctor @LupusMD]

The importance of complement activation in lupus nephritis is supported by our recently published paper in lupus science and medicine entitled “membrane attack complex deposition in renal tubules is associated with interstitial fibrosis and tubular atrophy: A pilot study”

[Lupus Doctor @LupusMD]

NYU Rheumatology publishes online in A&R regarding safety and efficacy of Covid vaccination in 90 SLE patients. No increased side effects and no increase in expected flares. 26/90 (29%) IgG responses low related to immunosuppression raising the possibility of a need for boosters.

[Lupus Doctor @LupusMD]

Aurinia’s IND application to FDA for voclosporin 1/2021 decision. AURORA phase 3 demonstrated superiority compared to standard of care treatment with MMF. However, 2 gm rather than full 3 gm doses of MMF used. Also best in class CNI debatable and MMF + tacrolimus also effective

[Lupus Doctor @LupusMD]

BLISS-LN endpoint: PERR (primary efficacy renal response)uPCR<.7 as opposed to CR(complete response) uPCR<.5 is supported by 3 studies establishing excellent prognosis at 7 years if this degree of proteinuria reduction is achieved at 1 year. Prefer term satisfactory response(SR)

[Lupus Doctor @LupusMD]

BLISS-LN Trial data encouraging and establishes a role for belimumab in lupus nephritis. Awaiting details to determine if supports use as first line treatment as opposed to for MMF and cyclophosphamide failures. One option is MMF alone and add benlysta if no early uPCR response

[Lupus Doctor @LupusMD]

POTUS “lupus on HCQ don’t get virus” Zhang “none of 80” patients on HCQ infected. As based on”follow-up survey” inadequate for inference. No data on total SLE sent survey Possibly SLE on HCQ with infection too ill to respond or SLE no HCQ also no infection falsely crediting drug

[Lupus Doctor @LupusMD]

HCQ “works” oversimplification Options pre-exposure postexposure prophylaxis, early active treatment, or sick patients. May/may not benefit all, some, or none options. For example, PrEP effect size of 30% incident cases 50/100 to 30/100 properly sized RCT still not a panacea

[Lupus Doctor @LupusMD]

A criticisms of the Zhang article demonstrating benefit HCQ in 31 of 62: insufficient information re control group. All patients eligible for steroids unstated use in each. No data on the presence or absence of underlying disease such as HTN, DM or smoking either in each group

[Lupus Doctor @LupusMD]

Anticoagulation Therapy Averts Valve Surgery for Antiphospholipid Syndrome Patient After Stroke | NYU Langone News https://t.co/86lh9az0FP

[Lupus Doctor @LupusMD]

Despite new guidelines admittedly promulgated by ophthalmologist not lupologists continue to use hydroxychloroquine early in serious disease >5mg/kg. However, some patients with late SLE would be well served by 300 mg doses. Need to petition Sanofi to make 100 mg tablet

[Lupus Doctor @LupusMD]

Anifrolumab effect size of 16% impressive especially considering the effect size in the BLYSS 52 and 76 trials were 9.7 and 12% using the SRI4; sufficient to earn Benlysta approval by the FDA. TULIP II used the BICLA after SRI4 not reached in TULIP I.

[Lupus Doctor @LupusMD]

AstraZeneca press release TULIP II reached primary endpoint: placebo vs 300 mg anifrolumab BICLA 32% vs 48%. Also OCS sparing 30% vs 52% and CLASI improved 25% vs 49%. Zoster 1% vs 7%

[Lupus Doctor @LupusMD]

As a MD, I believe in medical shared decision-making working with my patients allowing them to make the best choice for their treatment. Not sure how to proceed when for example patient doesn’t want to treat lupus nephritis despite abnl labs as often no symptoms until too late

[Lupus Doctor @LupusMD]

Once on dialysis lupus patient developing alveolar hemorrhage less likely due to pneumonitis and an immune mechanisms as opposed to fluid overload in association with uremic platelets or coagulopathy or an infectious process especially if lupus serology normal

[Lupus Doctor @LupusMD]

Biomarker predicting long-term outcome in lupus nephritis is desirable. 3 recent articles identified after 1 year of treatment 24 hour proteinuria with a cut off of 800 or 700 associates with preservation of function. NYU now reports albumin above 3.7 also predicts good outcome

[Lupus Doctor @LupusMD]

Voclosporin, cyclosporine with a single amino acid substitution, CNI effective for lupus GN. 24 & 48 week data superior to the SOC

[Lupus Doctor @LupusMD]

5-10% ANA false positive & nonpathogenic. DFS70 ANA pattern reassuring; not associated with lupus or systemic autoimmune rheumatic disease

[Lupus Doctor @LupusMD]

@Zavier_89 All3 CNI ClinicalTrials needed to determine if voclosporin more effective with less toxicity:eg renal toxicity HTN infection etc