Obinutuzumab in Active Systemic Lupus Erythematosus

To the Editor: The results of the ALLEGORY trial reported by Furie et al. (July 16 issue) 1 show that obinutuzumab was superior to placebo for treating patients with active systemic lupus erythematosus (SLE). Beyond the therapeutic implications, the trial highlights an important limitation of the end points used in current trials of treatment for SLE. A response on the SLE Responder Index 4 (SRI-4) was appropriately selected as the primary end point in the ALLEGORY trial because it measures overall disease activity. 2 However, SRI-4 was not designed to quantify treatment responses within individual organ systems. Consequently, clinically meaningful organ-specific improvement . . .