Objective: To investigate predictors of response, remission, low disease activity, damage, and drug discontinuation in patients with systemic lupus erythematosus (SLE) who were treated with belimumab. Methods: In this retrospective study of a multicenter cohort of SLE patients who received intravenous belimumab, the proportion of patients who achieved remission, low disease activity, and treatment response according to the SLE Responder Index 4 (SRI-4) was determined, and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) was used to score disease damage yearly over the follow-up. Predictors of outcomes were analyzed by multivariate logistic regression with the results expressed as odds ratios (ORs) and 95% confidence intervals (95% CIs). Results: The study included 466 patients with active SLE from 24 Italian centers, with a median follow-up period of 18 months (range 1–60 months). An SRI-4 response was achieved by 49.2%, 61.3%, 69.7%, 69.6%, and 66.7% of patients at 6, 12, 24, 36, and 48 months, respectively. Baseline predictors of response at 6 months included a score of ≥10 on the SLE Disease Activity Index 2000 (SLEDAI-2K) (OR 3.14 [95% CI 2.033–4.860]) and a disease duration of ≤2 years (OR 1.94 [95% CI 1.078-3.473). Baseline predictors of response at 12 months included a score of ≥10 on the SLEDAI-2K (OR 3.48 [95% CI 2.004–6.025]) and an SDI score of 0 (OR 1.74 [95% CI 1.036–2.923]). Baseline predictors of response at 24 months included a score of ≥10 on the SLEDAI-2K (OR 4.25 [95% CI 2.018–8.940]) and a disease duration of ≤2 years (OR 3.79 [95% CI 1.039–13.52]). Baseline predictors of response at 36 months included a score of ≥10 on the SLEDAI-2K (OR 14.59 [95% CI 3.54–59.79) and baseline status of current smoker (OR 0.19 [95% CI 0.039–0.69]). Patients who were in remission for ≥25% of the follow-up period (44.3%) or who had low disease activity for ≥50% of the follow-up period (66.1%) accrued significantly less damage (P = 0.046 and P = 0.007). A baseline SDI score of 0 was an independent predictor of achieving low disease activity in ≥50% of the follow-up period and remission in ≥25% of the follow-up period. Our findings suggest that the lower the baseline damage, the greater the probability of achieving remission over the course of ≥25% of the follow-up. Further, there was a negative association between the number of flares reported prior to belimumab initiation and the frequency of belimumab discontinuation due to inefficacy (P = 0.009). Conclusion: In patients with active SLE and low damage at baseline, treatment with belimumab early in the disease may lead to favorable outcomes in a real-life setting.

Early disease and low baseline damage as predictors of response to belimumab in patients with systemic lupus erythematosus in a real-life setting / Gatto, M.; Saccon, F.; Zen, M.; Regola, F.; Fredi, M.; Andreoli, L.; Tincani, A.; Urban, M. L.; Emmi, G.; Ceccarelli, F.; Conti, F.; Bortoluzzi, A.; Govoni, M.; Tani, C.; Mosca, M.; Ubiali, T.; Gerosa, M.; Bozzolo, E.; Canti, V.; Cardinaletti, P.; Gabrielli, A.; Tanti, G.; Gremese, E.; De Marchi, G.; De Vita, S.; Fasano, S.; Ciccia, F.; Pazzola, G.; Salvarani, C.; Negrini, S.; Puppo, F.; Di Matteo, A.; De Angelis, R.; Orsolini, G.; Rossini, M.; Faggioli, P.; Laria, A.; Piga, M.; Mathieu, A.; Scarpato, S.; Rossi, F. W.; de Paulis, A.; Brunetta, E.; Ceribelli, A.; Selmi, C.; Prete, M.; Racanelli, V.; Vacca, A.; Bartoloni, E.; Gerli, R.; Larosa, M.; Iaccarino, L.; Doria, A.. - In: ARTHRITIS & RHEUMATOLOGY. - ISSN 2326-5191. - 72:8(2020), pp. 1314-1324. [10.1002/art.41253]

Early disease and low baseline damage as predictors of response to belimumab in patients with systemic lupus erythematosus in a real-life setting

Ceccarelli F.;Conti F.;
2020

Abstract

Objective: To investigate predictors of response, remission, low disease activity, damage, and drug discontinuation in patients with systemic lupus erythematosus (SLE) who were treated with belimumab. Methods: In this retrospective study of a multicenter cohort of SLE patients who received intravenous belimumab, the proportion of patients who achieved remission, low disease activity, and treatment response according to the SLE Responder Index 4 (SRI-4) was determined, and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) was used to score disease damage yearly over the follow-up. Predictors of outcomes were analyzed by multivariate logistic regression with the results expressed as odds ratios (ORs) and 95% confidence intervals (95% CIs). Results: The study included 466 patients with active SLE from 24 Italian centers, with a median follow-up period of 18 months (range 1–60 months). An SRI-4 response was achieved by 49.2%, 61.3%, 69.7%, 69.6%, and 66.7% of patients at 6, 12, 24, 36, and 48 months, respectively. Baseline predictors of response at 6 months included a score of ≥10 on the SLE Disease Activity Index 2000 (SLEDAI-2K) (OR 3.14 [95% CI 2.033–4.860]) and a disease duration of ≤2 years (OR 1.94 [95% CI 1.078-3.473). Baseline predictors of response at 12 months included a score of ≥10 on the SLEDAI-2K (OR 3.48 [95% CI 2.004–6.025]) and an SDI score of 0 (OR 1.74 [95% CI 1.036–2.923]). Baseline predictors of response at 24 months included a score of ≥10 on the SLEDAI-2K (OR 4.25 [95% CI 2.018–8.940]) and a disease duration of ≤2 years (OR 3.79 [95% CI 1.039–13.52]). Baseline predictors of response at 36 months included a score of ≥10 on the SLEDAI-2K (OR 14.59 [95% CI 3.54–59.79) and baseline status of current smoker (OR 0.19 [95% CI 0.039–0.69]). Patients who were in remission for ≥25% of the follow-up period (44.3%) or who had low disease activity for ≥50% of the follow-up period (66.1%) accrued significantly less damage (P = 0.046 and P = 0.007). A baseline SDI score of 0 was an independent predictor of achieving low disease activity in ≥50% of the follow-up period and remission in ≥25% of the follow-up period. Our findings suggest that the lower the baseline damage, the greater the probability of achieving remission over the course of ≥25% of the follow-up. Further, there was a negative association between the number of flares reported prior to belimumab initiation and the frequency of belimumab discontinuation due to inefficacy (P = 0.009). Conclusion: In patients with active SLE and low damage at baseline, treatment with belimumab early in the disease may lead to favorable outcomes in a real-life setting.
2020
administration, intravenous; adult; antibodies, monoclonal, humanized; female; humans; immunosuppressive agents; logistic models; lupus erythematosus, systemic; male; middle aged; retrospective studies; secondary prevention; severity of illness index; treatment outcome
01 Pubblicazione su rivista::01a Articolo in rivista
Early disease and low baseline damage as predictors of response to belimumab in patients with systemic lupus erythematosus in a real-life setting / Gatto, M.; Saccon, F.; Zen, M.; Regola, F.; Fredi, M.; Andreoli, L.; Tincani, A.; Urban, M. L.; Emmi, G.; Ceccarelli, F.; Conti, F.; Bortoluzzi, A.; Govoni, M.; Tani, C.; Mosca, M.; Ubiali, T.; Gerosa, M.; Bozzolo, E.; Canti, V.; Cardinaletti, P.; Gabrielli, A.; Tanti, G.; Gremese, E.; De Marchi, G.; De Vita, S.; Fasano, S.; Ciccia, F.; Pazzola, G.; Salvarani, C.; Negrini, S.; Puppo, F.; Di Matteo, A.; De Angelis, R.; Orsolini, G.; Rossini, M.; Faggioli, P.; Laria, A.; Piga, M.; Mathieu, A.; Scarpato, S.; Rossi, F. W.; de Paulis, A.; Brunetta, E.; Ceribelli, A.; Selmi, C.; Prete, M.; Racanelli, V.; Vacca, A.; Bartoloni, E.; Gerli, R.; Larosa, M.; Iaccarino, L.; Doria, A.. - In: ARTHRITIS & RHEUMATOLOGY. - ISSN 2326-5191. - 72:8(2020), pp. 1314-1324. [10.1002/art.41253]
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