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Treatment for IgG4-related Disease to Improve Within Five Years

In This Article

  • Prednisone is the current standard of care for IgG4-related disease around the world
  • Three drugs, currently in clinical trials, could change treatment for IgG4-related disease in coming years
  • At a virtual conference, John H. Stone, MD, PhD, of Massachusetts General Hospital, described the risks of high prednisone use and the development of new treatment approaches

Three promising drugs—inebilizumab, rilzabrutinib and elotuzumab—are expected to improve standard treatment approaches for IgG4-related disease in the coming years. Reported by HealioJohn H. Stone, MD, MPH, director of Clinical Rheumatology at Massachusetts General Hospital, presented on the trio of drugs at the 2020 Congress of Clinical Rheumatology-West.

The standard of care for IgG4-related disease remains prednisone. Regimens of prednisone differ across Asia compared with treatment in North America and Europe, but both approaches involve high levels of prednisone and a high percentage of flares.

Dr. Stone explained that the critical cellular interaction in IgG4-related disease is when cells of the B lineage are presenting antigen to a particular CD4-positive cytotoxic T-cell. Inebilizumab, the subject of a worldwide phase 3 trial, is a drug that, according to Dr. Stone, "should hit an even broader spectrum of B cells than rituximab does."

Rilzabrutinib, another drug being evaluated, also targets B cells, but could potentially affect other cells like eosinophils and macrophages as well.

A third drug—elotuzumab—is a monoclonal antibody that has been given a breakthrough indication by the U.S. FDA. Elotuzumab is directed against SLAMF7, a surface marker found on B cells and CD4-positive cytotoxic T-cells that mediates homotypic interactions between cells.

Dr. Stone said that these ongoing trials could lead to meaningful changes to treatment approaches for IgG4-related diseases in the next three to five years.

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