Sep 25, 2026 · 1 hr · 11 segments
Professors Zahir Amoura and David Isenberg reflect with our host Dr Raquel Faria on the 15th Annual Lupus Academy Meeting in Bratislava. They discuss the debate over early biologic treatment and…
David IsenbergGuest
Zahir AmouraGuest
Raquel FariaHost
So let's just start with the opening debate, which was early biologic treatment in lupus, necessary or overemphasized? And Ricardo Severo moderated the interventions of both Mariella Gatto, who fought for the biologics as necessary in early treatment in lupus, And Chris Wincup, who counter argued that this was a little bit overemphasized.
Before the debate approximately 85% of the audience considered that early biologic therapy was necessary.
As you say, Marie Legato argued that biologics should no longer automatically be reserved until after conventional immunosuppressants fail.
She emphasized that early treatment might mean introducing targeted therapy before conventional immunosuppression, before measurable damage occurs, or within the early years of the disease.
Earlier targeted therapy may accelerate remission and renal response, reduce flares and glucocorticoid exposure, She also presented observational and postdoc evidence suggesting that early belimumab-based strategies may improve outcomes while acknowledging questions of cost and access.
Chris, in the counter-argument, said that biologics had a good value, but that calling them necessary early in every patient's disease is unsupported by the current evidence.
He also highlighted global access and cost, safety, the heterogeneity of SLE and the difficulty of knowing which biologic will work for which patient.
And much pivotal phase three evidence remains based on biologics added to standard care rather than genuine biologic first treatment.
So we had a very, very good debate, very good discussion on the issue, which is very important for the therapeutic management of SLE.
I think that it must be possible to use biologics whenever desired, depending on the patient's profile.
Conventional immunosuppressant can also be effectively used in certain patients.
However, I still believe that we have higher quality data regarding the use of biologics, particularly concerning the long-term efficacy, the risk of damage, relapse prevention, and corticoid sparing effects.
This is actually the third time these two people have had this debate this year.
Although I have to say, I was reminded very slightly, some years ago in London, there was a play called Frankenstein, which was put on at the National Theatre.
And there were two fantastic actors in the lead roles, Frankenstein and the guy who played the monster.
So let's just start with the opening debate, which was early biologic treatment in lupus, necessary or overemphasized? And Ricardo Severo moderated the interventions of both Mariella Gatto, who fought for the biologics as necessary in early treatment in lupus, And Chris Wincup, who counter argued that this was a little bit overemphasized.
Before the debate approximately 85% of the audience considered that early biologic therapy was necessary.
As you say, Marie Legato argued that biologics should no longer automatically be reserved until after conventional immunosuppressants fail.
She emphasized that early treatment might mean introducing targeted therapy before conventional immunosuppression, before measurable damage occurs, or within the early years of the disease.
Earlier targeted therapy may accelerate remission and renal response, reduce flares and glucocorticoid exposure, She also presented observational and postdoc evidence suggesting that early belimumab-based strategies may improve outcomes while acknowledging questions of cost and access.
Chris, in the counter-argument, said that biologics had a good value, but that calling them necessary early in every patient's disease is unsupported by the current evidence.
He also highlighted global access and cost, safety, the heterogeneity of SLE and the difficulty of knowing which biologic will work for which patient.
And much pivotal phase three evidence remains based on biologics added to standard care rather than genuine biologic first treatment.
So we had a very, very good debate, very good discussion on the issue, which is very important for the therapeutic management of SLE.
I think that it must be possible to use biologics whenever desired, depending on the patient's profile.
Conventional immunosuppressant can also be effectively used in certain patients.
However, I still believe that we have higher quality data regarding the use of biologics, particularly concerning the long-term efficacy, the risk of damage, relapse prevention, and corticoid sparing effects.
This is actually the third time these two people have had this debate this year.
Although I have to say, I was reminded very slightly, some years ago in London, there was a play called Frankenstein, which was put on at the National Theatre.
And there were two fantastic actors in the lead roles, Frankenstein and the guy who played the monster.
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