★ Rheumatologists warn of importance of vaccinating lupus patients

Vaccination should be a key focus for patients with systemic lupus erythematosus (SLE), a disease in which the immune system reacts “abnormally” and can cause damage to various organs. against certain infectious pathologies caused by their own disease or the treatment they receive (glucocorticoids, immunosuppressants and/or biological therapy), as shown by Dr. José Mª Pego, head of the Rheumatology Service of the Vigo Health District, during a virtual meeting organized by the Spanish Lupus Federation (Felupus), entitled “Informed patient, empowered patient”.

In his speech, the expert recalled the importance of vaccination in these cases, as it allows one to avoid certain infections or prevent their serious complications. «“Good collaboration between rheumatology, primary care and preventive medicine services, between nurses and doctors is essential to improve vaccination rates in patients with SLE,” he said.

In particular, Dr. Pego emphasized that lupus patients should receive the influenza and pneumococcal vaccines. For the human papillomavirus (HPV) vaccine, the vaccination recommendations for the general population should be followed. However, “in patients with SLE, the decision should be made individually based on the previous and future risk of HPV infection,” he emphasized, and mentioned the increased risk of herpes zoster virus (HZV) infection due to the characteristics of lupus or due to the use of certain medications, “so it is advisable to vaccinate them with a recombinant vaccine.”

“IN “In recent years, new vaccines or updates to recommendations have appeared, such as the pneumococcal vaccine or the VHZ vaccine,” explained Dr. Pego, who also highlighted a document prepared by the Spanish Society of Rheumatology and published in 2022: “SER recommendations for the prevention of infection in systemic autoimmune rheumatic diseases,” which includes numerous references to lupus patients.

The EPISER study estimates that in Spain, systemic lupus erythematosus (SLE) is prevalent in 0.21% of adults, which means that approximately more than 75,000 people suffer from it. However, this pathology can also debut in pediatric age.

The Vision of Felupus

The President of the Spanish Lupus Federation (Felupus), Silvia Pérez, assured: “In recent years, we have been carrying out intensive research with great hope, the results of which show improvements in the approach to lupus, as well as in prevention, by increasing the number of recommended vaccines. There is no point in having a weakened immune system to prevent it from attacking your own body, since it is an autoimmune disease, and not preventing potential infections that can complicate the development of lupus and endanger the patient’s life.”

Likewise, he insisted, “it is important that every advance be reflected in the provision of health care to each patient on an equitable basis, and in the case of prevention, to refer the patient to preventive medicine so that an individual examination and vaccination schedule can be made depending on the progress of the disease.” Lupus and its treatment.

CAR-T cell therapy: present and future

During a virtual meeting organized by Felupus, Dr. Iñigo Rua-Figueroa, rheumatologist at the Dr. Negrin University Hospital in Gran Canaria, explained that “at present, CAR-T cell therapy is only carried out with one specific method (CAR-. T CD19), successfully used in the treatment of refractory lymphomas, proving its effectiveness in isolated cases of lupus. Despite high expectations, this therapy will only be justified in patients who are very refractory to conventional treatments, which are currently often effective and safe. In fact, to date, CAR-T has no approved indication for lupus patients, and ideally its use should be limited to pilot studies or clinical trials in centers with experience in this type of therapy, which is very complex. ” .

“Few patients treated to date have had long-term remissions of the disease, particularly in the kidneys. Moreover, autoreactive B cells (‘abnormal’ cells that attack the tissue itself) appear to be undetectable after therapy, which is not the case with previous monoclonal antibody-based treatments (such as rituximab). The meaning and extent of this phenomenon is still not fully understood, but it is hoped that it will be an important milestone towards what could be called a ‘cure’, or at least the possibility of achieving comprehensive and long-term control of the disease,” he said. He also warned of “concerns about long-term safety, as well as the high cost of therapy.”

In the short term, it does not seem to cause serious side effects that would hinder or call into question the development of this therapy, but the cases treated have been few and the follow-up is relatively short. In this sense, he added, “a few weeks ago, the Spanish Medicines Agency (echoing what was published by the EMA) drew attention to the development of T lymphomas, many of which are derived from modified T lymphocytes, in some cancers of patients treated with CAR-T. The incidence is low (estimated at 0.8 per 1,000 patients treated), but more studies are needed to know the real extent of the problem. In short, this forces us to be cautious and establish strict surveillance in terms of safety.”

Finally, according to Dr. Rua-Figueroa, the prospects are “enormous” because biotechnologists are able to develop a much more “selective” CAR-T. While this may represent a “revolutionary approach,” this therapeutic method is still in the very early stages of development.

On behalf of Felupus, they point out the positive progress of this therapy, as well as the fact that it is evolving and reducing side effects, which leads to a promising future. “We have full confidence in the scientific search to improve or achieve a definitive cure for lupus among the various lines of open research, thereby achieving a decent quality of life for people suffering from it and avoiding mortality,” concluded Silvia Perez.

Source: Spanish Society of Rheumatology.