The Expanding Arsenal in Systemic Autoimmune Disease in 2025 and Beyond, With Orrin Troum, MD, and Alvin Wells, MD, PhD

After decades of limited options for patients with systemic lupus erythematosus (SLE), Sjögren syndrome, and related systemic autoimmune diseases, 2025 marked a year of genuine momentum — new approvals, emerging CAR-T data, and evolving treatment guidelines are collectively reshaping how rheumatologists approach some of the field's most treatment-resistant conditions.

To reflect on the year's advances and look ahead, we sat down with Alvin F. Wells, MD, PhD, director of the rheumatology department at American Medical Group in Destin, Florida, and adjunct assistant professor at the Duke University Medical Center, and Orrin Troum, MD, Clinical Professor of Medicine in the Division of Rheumatology at the Keck School of Medicine, University of Southern California, following their joint session on systemic autoimmune diseases at the 2026 Rheumatology Winter Clinical Symposium, held in Maui, Hawaii, on February 11–14. Wells, whose training in lupus dates to the 1980s under Edmund Dubois — author of the first textbook on the disease — brought particular historical perspective to just how far the field has come. Ianalumab approval for lupus nephritis, the availability of iptacopan and voclosporin, and growing early evidence behind CAR-T cell therapy were among the headline developments both physicians highlighted as transformative relative to the hydroxychloroquine-and-corticosteroid era that long defined lupus management.

A major theme threading through the session was guideline evolution — particularly around steroid reduction. Updated lupus nephritis guidelines, released at the EULAR meeting in Barcelona in late 2024, now support glucocorticoid tapering to 7.5 mg or below within 6 months of diagnosis, with data demonstrating this can be done safely. Both Wells and Troum emphasized the imperative of early, aggressive treatment in lupus nephritis specifically, with Wells invoking the phrase "time is nephrons" to underscore the irreversibility of delayed intervention. For Sjögren, the conversation was more forward-looking: with no disease-modifying therapies currently approved and prednisone offering limited benefit, both physicians expressed measured optimism about pipeline agents — including ianalumab from Novartis and other investigational compounds targeting upstream disease mechanisms — that could, for the first time, address the source of glandular and systemic inflammation rather than merely managing its symptoms.

“I make the analogy for treating Sjögren like the little boy putting the finger in the dam. I'm only kind of holding things off, and sometimes I get overwhelmed,” Wells said. “I can help with the dryness, but am I treating the cause of the disease? And with the drugs that we talked about here at the meeting, it gets to the source of the disease, not just the symptoms?”

Relevant disclosures for Wells include Abbvie, Bristol Myers Squibb, and others; disclosures for Troum include AbbVie/Abbott, Amgen, Bristol-Myers Squibb, Eli Lilly, Genentech, GlaxoSmithKlein, Novartis, Roche, and others.

Reference

Wells A, Troum O. Rheumatology 2025: Year in Review. Systemic autoimmune diseases (SLE, pSS, etc). Presented at: RWCS 2026, held February 11-14 in Maui, Hawaii.