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A Safer Strategy for Steroid Use in Patients with Lupus

LUPUS could now be treated with a lower dose of steroids, lessening the side effects experienced by patients and improving their health long-term. The research was published by Eric Moranand the Rheumatology Group at Monash University, Melbourne, Australia, who aimed to gain insight into ways of tracking patient exposure to steroidsCurrently, nearly 80% of people with systemic lupus erythematosus are treated with glucocorticoids, a class of steroid, yet there is no consensus on how much to give each patient for maximum efficacy and minimum side effects. Minimising the use of glucocorticoids is a global aim in the treatment of systemic lupus erythematosus.  

The team reported the identification of biological markers that can indicate how much glucocorticoids a patient with lupus has been exposed to; they found five genes that can indicate high levels of steroids in the body. Knowing the active amount of the steroid in the body is much more crucial than the amount taken by the individual. Patients with lupus are often prescribed much higher doses of glucocorticoids than other individuals with autoimmune disorders, but they are not always as effective. The team’s hypothesis was, therefore, that these patients may, to a variable extent, be resistant to steroids due to high levels of Type 1 interferon (IFN). On analysis, Type 1 IFN was found to prevent the glucocorticoids activating the geneshowever, the glucocorticoids did not stop the IFNs effect on gene expression. The individuals who had higher levels of Type 1 IFN were also found to have a higher level of disease activity.  

The results give insight into the mechanism by which IFN may causes steroid resistance in patients with lupus and suggest that targeting the IFN pathway to block Type 1 IFN activity may increase the effectiveness of steroids, thereby presenting an opportunity to lower the dose. 

Teodora Staeva, Chief Scientific Officer at Lupus Research Alliance, New York City, New York, USA, commended the team: “High steroid use is a major issue for people with lupus, often causing long-term organ damage and numerous other side effects. These findings point to a potential approach to guide glucocorticoid treatment and cut down on their use, which could make a significant difference in how patients fare over time.”