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Smoking and pre-existing organ damage reduce the efficacy of belimumab in systemic lupus erythematosus
Karolinska University Hospital, Sweden.
Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
Lund University, Sweden.
Karolinska University Hospital, Sweden.
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2017 (English)In: Autoimmunity Reviews, ISSN 1568-9972, E-ISSN 1873-0183, Vol. 16, no 4, 343-351 p.Article, review/survey (Refereed) Published
Abstract [en]

Objectives: Belimumab is the first biologic drug approved for Systemic Lupus Erythematosus (SLE). Here, we aimed to investigate the effects of belimumab on clinical and serologic outcomes, and sought to identify predictors of treatment response in three Swedish real-life settings. Methods: Fifty-eight patients were enrolled at initiation of belimumab and followed longitudinally for up to 53 months. Surveillance outcomes included the SLE Disease Activity Index 2000 (SLEDAI-2K), 100 mm Visual Analogue Scales for Physicians Global Assessment (PGA), fatigue, pain and general health, and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). Assessment of treatment response included the SLE responder index (SRI). B lymphocyte stimulator (BLyS) levels were determined using ELISA. Results: SLEDAI-2K (median baseline score: 8.0; IQR: 4.0-13.8), PGA and corticosteroid use decreased during therapy, and patients reported improvements on fatigue, pain, and general health (p amp;lt; 0.0001 for all). SDI scores remained stable (p = 0.08). Patients with baseline SDI scores amp;gt;1 showed decreased probability and prolonged time to attain SRI response (HR: 0.449; 95% CI: 0.208-0.967), as did current smokers compared with nonsmokers (HR: 0.103; 95% CI: 0.025-0.427). In contrast, baseline BLyS levels amp;gt;= 12 ng/mL predicted increased probability and shorter time to attain SRI response (HR: 2.566; 95% CI: 1.222-5.387). Conclusions: Disease activity and corticosteroid usage decreased, patient-reported outcomes improved, and no significant organ damage was accrued during follow-up. Smoking and organ damage predicted reduced treatment efficacy. These findings might contribute to a better selection of patients who are likely to benefit from belimumab. (C) 2017 Elsevier B.V. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE BV , 2017. Vol. 16, no 4, 343-351 p.
Keyword [en]
Systemic lupus erythematosus; Biologics; Belimumab; BLyS; BAFF
National Category
Rheumatology and Autoimmunity
Identifiers
URN: urn:nbn:se:liu:diva-137090DOI: 10.1016/j.autrev.2017.02.005ISI: 000399266200003PubMedID: 28216072OAI: oai:DiVA.org:liu-137090DiVA: diva2:1093269
Note

Funding Agencies|Swedish Research Council; Swedish Rheumatism Association; King Gustaf Vs 80-year Foundation; Swedish Society of Medicine; Professor Nanna Svartz Foundation; Swedish Heart-Lung Foundation; Foundation in memory of Clas Groschinsky; Stockholm Council; Ostergotland County Council; Karolinska Institutet Foundations; Lund University Medical Faculty Foundation; Alfred Osterlunds Foundation; Anna-Greta Crafoord Foundation; Greta and Johan Kocks Foundation; Lund University Hospital

Available from: 2017-05-05 Created: 2017-05-05 Last updated: 2017-05-05

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CiteExportLink to record
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