El-Gabalawy also made a final point that “if we did treat this [pre-RA] population with existing therapies that only delay the onset [of RA], how are we going to find study participants to discover treatments that really prevent RA?”

David Klatzmann (Sorbonne Université, Paris, France) and co-investigators explain that insufficiency of Tregs due to a shortage of IL-2 “is central to the pathophysiology” of SLE, but there are currently no approved treatments targeting this pathway.

And that may be a way out of this repeated cycles of B-cell depletion blocking the antibody response.

Patient awareness and communicating risks For some patients, the pandemic has increased their awareness of the link between rheumatic diseases, their treatments, and infection risk, and Wallace anticipates that this may affect patient–physician communication going forward.

The team notes that there was no significant correlation between B-cell numbers and serologic response in RA patients on other treatments or healthy controls, suggesting that the association “is restricted to patients with B cell counts below the lower limits of normal.”

They stress that a number of questions about rituximab and COVID-19 vaccination still need to be addressed, including the impact of booster doses, the importance of T cell-mediated immunity, and the optimal timing of rituximab therapy.

Although Petri advocated for belimumab in the debate, she said: “I think if our Great Debate is successful, you will feel comfortable using both of these new treatments for lupus nephritis.”

Do patients need to stop or alter RMD drug treatments when having a COVID-19 vaccine?  

However, most treatments in pediatric patients are off-label drugs with recommendations based on inadequately powered studies, therapeutic consensus guidelines, or case series.

Autologous hematopoietic stem cell transplantation leads to early and sustained clinically relevant improvements in health-related quality of life among patients with systemic sclerosis, study findings indicate.

Autologous hematopoietic stem cell transplantation leads to early and sustained clinically relevant improvements in health-related quality of life among patients with systemic sclerosis, study findings indicate.

The guidance for IL-1, IL-6, and JAK inhibitors similarly states that an adequate supply must be maintained for patients who need these agents, given that they are used to treat a variety of rheumatic diseases including RA, giant cell arteritis, and juvenile idiopathic arthritis.

Georgia World Congress Center, Atlanta, USA Moderators:  Kenneth Kalunian, USA; Saira Sheikh, USA B Cell Therapies: How the Past Informs the Future  David Isenberg, UK The Interferon Story: More to Come  Richard Furie, USA Looking to the Future of Lupus Therapies Daniel Wallace, USA

A risk that Curtis pointed out is increased further for those taking treatments commonly used to treat the inflammatory disorders.

“As new and more effective treatments emerge, following the example set in other rheumatic diseases, [T2T] approaches are likely to become part of the standard of care in SLE,” they add.

Daniel Furst and Nihal Fathi present a case of a patient with diffuse systemic sclerosis who undergoes autologous hematopoietic stem cell transplantation after failing two other therapies.

Daniel Furst and Nihal Fathi present a case of a patient with diffuse systemic sclerosis who undergoes autologous hematopoietic stem cell transplantation after failing two other therapies.

They add that “future clinical studies for low-dose IL-2 therapy should recruit a larger cohort and stratify patients based on background treatments,” which would allow them to analyze “the therapeutic efficacy of low-dose IL-2 without the interference of background treatments.”