A large meta-analysis published in Lupus Science & Medicine suggests that routine serologic markers and baseline disease activity may help physicians identify which patients with lupus are most likely to benefit from biologic therapies.

Researchers analyzed 31 randomized controlled trials involving more than 17,000 patients. Overall, biologic therapies were associated with higher rates of clinical response compared with standard treatment, based on SLE Responder Index-4 outcomes.

However, treatment response varied across patient subgroups. The strongest association was seen in patients with serologically active disease, particularly those with both anti–double-stranded DNA (dsDNA) antibodies and low complement levels. Patients in this group were more likely to respond to biologic therapy than those without these features.

Higher baseline disease activity also appeared to be associated with improved response. Patients with a systemic lupus erythematosus Disease Activity Index score of 10 or greater showed greater benefit from biologics compared with those with lower disease activity.

Among biologic classes, therapies targeting B-cell activating factor demonstrated the most consistent efficacy across trials. Other mechanisms, including interferon-targeting therapies and Janus kinase inhibitors, showed more variable results.

Biologic therapies were also associated with a modest reduction in serious adverse events overall, although this finding may reflect improved disease control rather than a direct reduction in treatment-related risks. Rates of herpes zoster were slightly higher among patients receiving biologics.

The findings suggest that routine laboratory markers and disease activity measures may help physicians identify patients more likely to respond to biologic therapy.

The study authors reported no competing interests and no specific funding.

Source: Lupus Science & Medicine