Refractory autoimmune disease: an overview of when first-line therapy is not enough.
A recent Intercontinental Cooperative ITP Study Group (ICIS) meeting in September 2015 focused on immunomodulation across the spectrum of autoimmune conditions. It became clear to the attendees that in this wide range of conditions, there is a subset of patients that remain highly refractory to first line therapy. Therapeutic approaches to these patients vary greatly and while many different immunomodulatory agents have been investigated, few have seen universal success. We outline here the landscape of immunomodulation therapy for refractory patients across a variety of autoimmune conditions in order to highlight the variety of agents that have been studied, the lack of overall consensus about management, and the need for ongoing research in this area.
Department of Pediatrics, Columbia University Medical Center, New York, NY, USA. Electronic address: cn2401@cumc.columbia.edu.
Cindy
C
Neunert
Department of Pediatrics, Saint George Hospital University Medical Center, Beirut, Lebanon.
Roula
R
Farah
Department of Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Joanne
J
Yacobovich
Dana-Farber/Boston Children's Center for Cancer and Blood Disorders, Boston, MA, USA.
Ellis
E
Neufeld
D001327:Autoimmune Diseases / Q000276:immunology*; D006801:Humans; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000276:immunology / Q000628:therapy*
Autoimmune disease; ITP; Immunomodulatory therapy