“If we knew what it was we were doing, it would not be called research, would it?”
An Investigation of the Role of Precision Medicine in the Treatment of Systemic Lupus Erythematosus
Systemic lupus erythematosus (SLE) is a serious autoimmune disease that disproportionately impacts women, representing approximately 90% of cases. The diagnosis of SLE is difficult as the symptoms masquerade as other illnesses, there are no specific SLE diagnostic tests, and diagnoses are based on patient history, symptoms exhibited, patient examinations, and multiple medical tests that rule out other diseases such as damage to the liver, kidney and heart, and clotting cascade. As such, SLE diagnoses are often delayed or missed, and patients are given treatments to manage the symptoms, which leads to increased healthcare costs and prolonged hospital stays.
Due to the complexity of and multiple factors associated with SLE disease progression, precision medicine approaches, including incorporating genetic, environmental, and lifestyle factors into treatment decisions, including the use of Anifrolumab, will allow the tailoring of treatments for individual patients and potentially eliminate or significantly reduce the number of flare-ups. In this systematic review of the literature (SLR) and quantitative descriptive analysis of HCUP data, the effectiveness of Anifrolumab as a precision medicine treatment for SLE patients in the context of all available patient data was examined. The results further confirmed the role genetic variation in SLE and the disproportionate impact of SLE on women of color. Disappointingly, there is a lack of representation of women of color – the patient population most significantly affected by SLE – in clinical trials and existing research.
We conclude that although Anifrolumab shows promise as a precision medicine intervention, that due to genetic variations associated with SLE, as well as variations in environmental and lifestyle factors also linked to ethnicities which also affect SLE onset and progression, that without the representation of the ethnic and racial populations most affected by the disease in research and clinical trials, that the full promise of Anifrolumab and other therapeutic and preventative interventions will fall short.
The key recommendation from this study is to improve the representation of minority patient populations within future research, particularly in clinical trials, to improve the evidence base for the use of Anifrolumab particularly among minority patient populations.