Universiteit Leiden

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Better treatment of systemic autoimmune diseases requires close collaboration

Exceptional collaboration between physicians is needed to better understand and treat autoimmune diseases that cause inflammation in various organ systems. Onno Teng, Professor of Renal Autoimmune Diseases, explains how the LUMC is trying to provide even better care to patients.

In systemic autoimmune diseases, an overactive immune system causes inflammation in various organ systems. The LUMC has an expertise centre for these types of autoimmune diseases. What exactly do they do there?

‘In this centre, there is very close collaboration between physicians and researchers from specialities such as rheumatology, pulmonary diseases, internal medicine, dermatology and gynaecology. That collaboration is highly effective. As a result, we are national and international leaders in the development of new treatments for these patients. For example, we are working on treatments that do not target the entire immune system, but parts of it. These treatments modify patients’ immune systems so only the immune cells that cause or contribute to the disease are targeted. This lets us phase out the current immunosuppressive treatments, such as prednisone, in some patients.’

What are these treatments?

‘In an autoimmune disease, the immune system attacks a person’s own body. This is associated with the presence of autoantibodies. These are produced by B cells that are ultimately triggered to develop into plasma cells. We are constantly trying to develop and improve therapies that specifically target those B cells and plasma cells. In Leiden, we have pioneered a combination therapy using two existing drugs (rituximab and belimumab) that we have shown can reinforce each other.

‘Patients with an autoimmune disease also have an overactive complement system. At the LUMC, we have been studying complement inhibitors in difficult-to-treat patients with ANCA-associated vasculitis (in which blood vessels are damaged and occluded by an inflammatory process, Ed.). If we can better understand the cause, we can treat it more precisely and figure out for which patient a treatment works best.’

‘I am a great advocate of expertise networks in which expertise, not care, is centralised.’

You also want to strengthen the strong collaboration outside the LUMC. In what way?

‘I am a great advocate of expertise networks in which expertise, not care, is centralised. The patient gets care from a physician close to home but is assured of collaboration with a specialist centre, such as at the LUMC. It is one of the driving forces behind my chairmanship of the external, national Autoimmune Research and Collaboration Hub (ARCH). That foundation has a website where patients and healthcare providers can find more information about expertise networks for systemic autoimmune diseases in the Netherlands. In addition, healthcare providers can register patients for an expert consultation. This makes it easy for the physician to discuss the clinical case with other experts.’

What are the benefits of expertise networks?

‘The expertise is transparent; the patient knows there can be collaboration with an expertise centre. And as the expertise is easily available, the patient gets the best care without having to commute between different hospitals. Obviously, this is much less strenuous for the patient. In addition, it helps to have a simple way to share specialist knowledge with physicians in the network and to ensure this knowledge is of a continously high standard.’

You were appointed Professor of Renal Autoimmune Diseases (focusing on kidneys) last year, and you will give your inaugural lecture soon. What is the main message you want to convey?

‘I am working hard on improving treatment strategies for patients with renal autoimmune diseases. One part of this involves collaborating with colleagues on research into new treatments. But ultimately, you have to get all those innovative treatments to the patient. Cooperation both inside and outside the hospital walls is essential to that. We also need to teach medical students and trainee doctors about this. Cooperation is often taken for granted, but it should not be. It requires seeing walls as glass doors. So alongside research, as a professor I am passionately committed to this.’

This article previously appeared on the LUMC website.

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