Rob Volansky , 2025-05-03 09:30:00
DESTIN, Fla. — Raising the rheumatology community’s “aspirations” for immune-mediated inflammatory disease treatment could lead to better patient outcomes, according to a speaker at the Congress of Clinical Rheumatology East annual meeting.
“Most of our decisions in chronic disease are not bad, but they do not resolve the condition,” Iain McInnes, MD, PhD, professor of medicine and rheumatology at the University of Glasgow, told attendees.
“Most of our decisions in chronic disease are not bad, but they do not resolve the condition,” Iain McInnes, MD, PhD, told attendees. Image: Rob Volansky | Healio
Regardless of the quality of the decisions, one fact remains clear in the treatment of immune-mediated diseases: “We do not normally get to remission, even in good practice,” McInnes said.
Moreover, most patients do not experience repair of damaged tissue or resumption of immune homeostasis, according to McInnes.
“Treatment strategies are challenging despite having tools at our disposal,” he said.
McInnes called on the rheumatology community to increase efforts in all facets of immune-mediated disease management.
“We have become quite lazy in the IMID field,” he said. “We ask pharma and biotech to spend half a billion dollars in another phase 3 trial. We have to be much more creative and imaginative about what we are trying to do.”
Although McInnes is cautiously optimistic regarding early data from chimeric antigen receptor T-cell therapy in rheumatology, he cautioned that its development in lupus and other IMIDs demonstrates the shortcomings of previous thinking.
“How disappointing would it be if after 30 years of studying the immune system, the answer would be to blow away the whole B-cell compartment?” he said.
With these shortcomings and ongoing challenges in mind, McInnes framed his presentation in terms of five “aspirations” for the rheumatology community to consider.
The first aspiration is to shift the recommendations within guideline documents from those that apply to broad patient populations to those that are “far more individualizable.”
“The domains have to be agreed on and then actionable,” McInnes said.
The next aspiration is to gain a deeper understanding of the “organized structures” of immune-mediated diseases.
“We need a better understanding of the pathologies and pathways in IMIDs,” McInnes said. “They may appear chaotic, but they are not.”
The third aspiration for attendees to consider pertains to how different tissues in the body are treated.
“We still think of the synovium, enthesis, skin and lung as comparable tissue,” McInnes said. “But the immune system will react differently in different types of tissues.”
Although McInnes is encouraged by the recent movement toward individually defined treatment decisions and paradigms, he suggested that tailoring therapies to the impacted tissue may yield even better results.
“We should treat to target across discrete tissues,” he said.
Further understanding of the “disordered kinetics” of immune responses was the basis of the fourth aspiration. McInnes described immune response as “disordered” and difficult to trace, particularly in patients with long-standing diseases.
“For example, we do not even know when psoriatic disease truly transitions [from psoriasis to PsA],” he said.
The final aspiration concerns the exposome. McInnes suggested that it is critical to understand patients’ exposures to everything from smoke to stress to air pollution, because all of these are factors in how their disease will progress.
“The ultimate in understanding the people with our diseases is understanding where they have been,” he said. “That will help us understand where they will go moving forward.”
Curiosity should underpin all these aspirations, according to McInnes.
“The future belongs to people who ask the best questions,” he said. “We have to retain the acute art of interrogation.”
Sources/Disclosures
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McInnes I. A Look Into the Future: Reflections on Decision Making in Rheumatology. Presented at The Congress of Clinical Rheumatology East; May 1-4, 2025; Destin, Florida (hybrid meeting).
Disclosures:
McInnes reports research funding and honoraria from AbbVie, AZ, Absci, Amgen, Anaptys, Bristol Myers Squibb, Boehringer, Compugen, Cabaletta, Causeway, Dextera, Eli Lilly & Co., GlaxoSmithKline, Moonlake, MSD, Montai, Pfizer, Novartis, Janssen, Recludix, Takeda and UCB; as well as research support from Versus Arthritis, MRC & Wellcome Trust.
