Eating properly is important when you have lupus
Diet used in 2020 rheumatoid arthritis study above
Slides above and below posted with permission of Dr. Monica Guma, MD (principal investigator of this research study. The reference is at the bottom)
At the American College of Rheumatology (ACR) meeting NOV 2020, Dr. Monica Guma of UCSD reported results of using an anti-inflammatory diet in the autoimmune disease, rheumatoid arthritis (rheumatoid arthritis). She used the diet posted above.
This is pertinent for lupus patients because lupus is also an autoimmune disease. Note that there are some anti-inflammatory diet studies in lupus mice and lupus humans that show positive effects. However, we need larger, bigger studies. This study is a step in the right direction (even though it is with RA instead of lupus).
She chose motivated RA patients. They stayed on their medications as well. They followed the above diet. They had to have active RA to enter the study. Disease activity was measured 2 weeks before the study, at the start of the study, then 2 weeks later. The bacteria in their stool (microbiome) was also measured!
Below is an example of a typical day of eating:
How did the RA patients do on this anti-inflammatory diet?
After 2 weeks on the diet, there was improved disease activity (overall) with less tender and swollen joints.
Disease activity (measured by a research tool called the CDAI) was significantly decreased.
Below are the results after 2 weeks on the diet.
For the scientific minded... note the great "p values" for some of these measurements on the right.
What did their gut microbiome do in response to the anti-inflammatory diet?
After 14 days, those RA patients who did better (had lower RA disease inflammation) on the anti-inflammatory diet ended up with a greater diversity of their microbiome. This suggests that the diet influenced their gut bacteria types as well as improved disease activity.
This adds evidence that we may be able to alter our gut bacteria with diet plus improve disease activity in autoimmune diseases! There is hope that diet could also possibly help other autoimmune diseases, such as lupus, in a similar way.
We absolutely need more research. Thanks to Dr. Guma and her team for helping to pave the way for more research on diet and autoimmune disorders. Below are her results of the microbiome changes in the study.
What should be in an anti-inflammatory diet for lupus and other autoimmune diseases?
This is my commentary:
Some of the recommendations of Dr. Bustamante (first two pics above) have quite a bit of research supporting their use (eating foods high in omega-3, avoiding omega-6, eating prebiotics) in autoimmune diseases such as lupus.
However, others have significantly less evidence (for example, avoiding solanaceae, which is nightshade plants, and eating gluten-free).
I suspect the latter food groups were included since these changes "may possible reduce inflammation."
We all look forward to more studies in autoimmune disorders, such as lupus.
Click on COMMENTS above
What have you found to be helpful in an anti-inflammatory diet?
What do you recommend for a beginner?
Do you recommend any particular books that you found to be most helpful?
Don Thomas, MD author of "The Lupus Encyclopedia" and "The Lupus Secrets"
Hot off the press SEP 2020! The future is very bright for lupus treatments!
The future has never been brighter for lupus patients!
We have 3 drugs that are vying for FDA approval soon: Benlysta (belimumab) for lupus nephritis, voclosporin for lupus nephritis, and anifrolumab for systemic lupus erythematosus (SLE). All three were successful in the final research studies (called phase 3 clinical trials). In medical-speak, we say that "they met their primary endpoints."
My (Don Thomas, MD) prediction:
Though meeting the primary endpoints in phase III clinical trials never guarantees FDA-approval (many do not), these did so well, I predict they will be the next 3 FDA-approved therapies! They all did so well, along with having excellent safety profiles (low side effects for the amount of benefits they provided).
SHARE this with all lupus patients. Everyone needs some optimism.
Why is this so joyous? In March 2011, Benlysta was the very first FDA-approved drug for lupus since President Eisenhower was president (it took over 50 years!). That is a travesty. However, the approval of Benlysta showed pharmaceutical companies that it was worth their time, effort, and money to actively research lupus in more depth and that drugs could be proven to be helpful in treating SLE. And now... we have possibly 2 new drugs just around the corner (voclosporin and anifrolumab)? Yes, it is time to rejoice, hope, and pray that the FDA finds the research results to be as good as they appear.
This post, though, is all about Benlysta. Just this week, the New England Journal of Medicine published the positive results of their research study called BLISS-LN (Link to the study is below). This stands for "BeLImumab in Subjects with SLE with Lupus Nephritis study." It showed that Benlysta is effective for lupus nephritis.
Let's 1st briefly discuss lupus nephritis ...
When lupus attacks a person's kidneys it is called lupus nephritis (nephr- refers to kidneys, -itis means inflammation). Depending on the study, overall, approximately 50% of SLE patients will get this major problem. In some populations it is much more common (such as in over 70% of Caribbean-African people with SLE), and as low as 30% in Caucasians with SLE. When caught early and treated quickly, most patients go into low disease activity or remission. If not, it can cause kidney failure, the need for dialysis, and the need for kidney transplantation. Along this very hard road, lots of deaths occur.
This is why rheumatologists ask to see their patients every 3 months. We want a urine sample to evaluate and make sure our patient isn't getting lupus nephritis. When I see it as a possibility, I pounce on it and treat it aggressively. Using this approach, my only patients who have gone into kidney failure and dialysis, and then kidney transplantation were my patients who were poorly adherent to their therapy. By the way, don't let that happen to you!
Read and abide by my Lupus Secrets. If you follow them, you'll successfully fight your lupus.
Now for the study, in brief.
They had 224 patients in the placebo group and 224 patients on Benlysta. However, it wasn't really placebo. The "placebo" group was getting standard of care (steroids plus either cyclophosphamide or CellCept, mycophenolate). Those who received Benlysta had their Benlysta in addition to the "standard of care."
It had some impressive results after 104 weeks:
30% of the Benlysta group had a complete response to therapy while 20% of the placebo group did. That is 50% greater in the Benlysta group compared to standard of care plus placebo group. This is impressive. The "placebo group" is how we currently treat lupus nephritis patients! Imagine getting a 50% higher response rate by adding another medicine.
By the way, you may think, well an additional drug! That could mean more side effects. Guess what? ... Serious adverse events occurred in 30% of those on standard of care treatment plus placebo, while 26% of those on Benlysta plus standard of care had serious side effects. This is actually less in the Benlysta group. However, that does not mean that Benlysta causes less side effects. This is actually not statistically significant.
Also, don't think this is "horrible" that 30% of patients had "serious adverse events." Guess what would have happened without these treatments? ... virtually 100% serious adverse events would have occurred due to the lupus nephritis leading to kidney failure, dialysis, kidney transplantations and deaths. (the benefits of the medicines greatly outweigh their potential side effects compared to this).
By the way, there were other impressive positive results in the study, but I wanted to hone in on the "complete renal response" result above.
Remarkably, there were only 3 deaths (2 on placebo, 1 on Benlysta), only one patient went into complete kidney failure (a placebo patient). Impressive when you realize how horrible the alternative without treatment would have been.
I've been using Benlysta since 2011, and I have many SLE patients who are in low disease activity and remission after failing other treatments. This includes quite a few lupus nephritis patients. In my experience, it is one of the safest medicines we have for SLE. Plaquenil is probably the only safer drug.
The primary downside of Benlysta: EXPENSIVE!
It comes in two forms of dosing ... a self injectable every other week form, or a monthly IV (intravenous form). According to UpToDate.com, the self-injectable form costs close to US$ 30,000 a year. The IV form is more expensive (nurses, IV equipment, etc.)
So some big, important questions are:
Which patients will benefit the most?
Can we figure out which patients are at highest risk for not responding completely to standard of care therapy (CellCept and cyclophosphamide)?
If we could figure this out, then those patients should be the ones who get it.
It will be interesting to see what happens if it gets FDA-approved for lupus nephritis. I cannot imagine it not getting FDA approval, by the way. The study was that impressive.
Bottom Line?: Lots of exciting stuff happening in lupus!
Please COMMENT in "LEAVE A REPLY" below.
Are you on Benlysta? How are you doing? What is your experience like? Do you have lupus nephritis? How have you done?
I love giving good news!
- Don Thomas, MD
P.S. Remember to download my Lupus Secrets to learn more!
Reference: Furie R, et al. Two-Year, Randomized, Controlled Trial of Belimumab in Lupus Nephritis. NEJM SEP 2020;383:1117-1128
Disclosure: I am on the Speaker's Bureau for GSK, maker of Benlysta. This is the only pharmaceutical Speaker's Bureau I am on. I truly believe in Benlysta as being a great therapy for SLE patients. It is not for everyone, but many do great on it.
Don Thomas, MD
I specialize in taking care of patients with systemic lupus. I enjoy sharing helpful, practical information for them to use and be better able to live with and successfully fight against their disease. Make sure to read and follow my Lupus Secrets
Note that Dr. Thomas' posts are for informational purposes only, and are not meant to be specific medical advice for individuals. Always seek the advice of your healthcare provider with any questions regarding your own medical situation.
DONALD THOMAS, MD