Advanced

Smoking and pre-existing organ damage reduce the efficacy of belimumab in systemic lupus erythematosus

Parodis, Ioannis; Sjöwall, Christopher; Jönsen, Andreas LU ; Ramsköld, Daniel; Zickert, Agneta; Frodlund, Martina; Sohrabian, Azita; Arnaud, Laurent; Rönnelid, Johan and Malmström, Vivianne LU , et al. (2017) In Autoimmunity Reviews 16(4). p.343-351
Abstract

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 Physician's 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... (More)

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 Physician's 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 < 0.0001 for all). SDI scores remained stable (p = 0.08). Patients with baseline SDI scores > 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 non-smokers (HR: 0.103; 95% CI: 0.025–0.427). In contrast, baseline BLyS levels ≥ 1.2 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.

(Less)
Please use this url to cite or link to this publication:
author
, et al. (More)
(Less)
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
BAFF, Belimumab, Biologics, BLyS, Systemic lupus erythematosus
in
Autoimmunity Reviews
volume
16
issue
4
pages
9 pages
publisher
Elsevier
external identifiers
  • scopus:85016216057
  • wos:000399266200003
ISSN
1568-9972
DOI
10.1016/j.autrev.2017.02.005
language
English
LU publication?
yes
id
0bf2cadf-9bff-417a-a6a1-614ae8866c56
date added to LUP
2017-04-26 14:43:07
date last changed
2018-01-14 04:31:56
@article{0bf2cadf-9bff-417a-a6a1-614ae8866c56,
  abstract     = {<p>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 Physician's 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 &lt; 0.0001 for all). SDI scores remained stable (p = 0.08). Patients with baseline SDI scores &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 non-smokers (HR: 0.103; 95% CI: 0.025–0.427). In contrast, baseline BLyS levels ≥ 1.2 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.</p>},
  author       = {Parodis, Ioannis and Sjöwall, Christopher and Jönsen, Andreas and Ramsköld, Daniel and Zickert, Agneta and Frodlund, Martina and Sohrabian, Azita and Arnaud, Laurent and Rönnelid, Johan and Malmström, Vivianne and Bengtsson, Anders A. and Gunnarsson, Iva},
  issn         = {1568-9972},
  keyword      = {BAFF,Belimumab,Biologics,BLyS,Systemic lupus erythematosus},
  language     = {eng},
  month        = {04},
  number       = {4},
  pages        = {343--351},
  publisher    = {Elsevier},
  series       = {Autoimmunity Reviews},
  title        = {Smoking and pre-existing organ damage reduce the efficacy of belimumab in systemic lupus erythematosus},
  url          = {http://dx.doi.org/10.1016/j.autrev.2017.02.005},
  volume       = {16},
  year         = {2017},
}