De novo lupus nephritis during treatment with belimumab
(2021) In Rheumatology (Oxford, England) 60(9). p.4348-4354- Abstract
OBJECTIVE: In light of reports of de novo LN during belimumab (BLM) treatment, we sought to determine its frequency and contributing or protective factors in a real-life setting. METHODS: Patients with SLE who received BLM between 2011 and 2017 at five European academic practices were enrolled (n = 95) and followed longitudinally for a median time of 13.1 months [interquartile range (IQR): 6.0-34.7]; 52.6% were anti-dsDNA positive, 60.0% had low complement levels, and 69.5% had no renal involvement prior to/at BLM initiation [mean disease duration at baseline: 11.4 (9.3) years]. Age- and sex-matched patients with non-renal SLE who had similar serological profiles, but were not exposed to BLM, served as controls (median follow-up: 132.0... (More)
OBJECTIVE: In light of reports of de novo LN during belimumab (BLM) treatment, we sought to determine its frequency and contributing or protective factors in a real-life setting. METHODS: Patients with SLE who received BLM between 2011 and 2017 at five European academic practices were enrolled (n = 95) and followed longitudinally for a median time of 13.1 months [interquartile range (IQR): 6.0-34.7]; 52.6% were anti-dsDNA positive, 60.0% had low complement levels, and 69.5% had no renal involvement prior to/at BLM initiation [mean disease duration at baseline: 11.4 (9.3) years]. Age- and sex-matched patients with non-renal SLE who had similar serological profiles, but were not exposed to BLM, served as controls (median follow-up: 132.0 months; IQR: 98.3-151.2). RESULTS: We observed 6/66 cases (9.1%) of biopsy-proven de novo LN (4/6 proliferative) among the non-renal BLM-treated SLE cases after a follow-up of 7.4 months (IQR: 2.7-22.2). Among controls, 2/66 cases (3.0%) of de novo LN (both proliferative) were observed after 21 and 50 months. BLM treatment was associated with an increased frequency and/or shorter time to de novo LN [hazard ratio (HR): 10.7; 95% CI: 1.7, 67.9; P = 0.012], while concomitant use of antimalarial agents along with BLM showed an opposing association (HR: 0.2; 95% CI: 0.03, 0.97; P = 0.046). CONCLUSION: Addition of BLM to standard-of-care did not prevent LN in patients with active non-renal SLE, but a favourable effect of concomitant use of antimalarials was implicated. Studies of whether effects of B-cell activating factor inhibition on lymphocyte subsets contribute to LN susceptibility are warranted.
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- author
- Parodis, Ioannis ; Vital, Edward M. ; Hassan, Sabih Ul ; Jönsen, Andreas LU ; Bengtsson, Anders A. LU ; Eriksson, Per ; Leonard, Dag ; Gunnarsson, Iva ; Rönnblom, Lars and Sjöwall, Christopher
- organization
- publishing date
- 2021-09-01
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- adverse events, autoantibodies, belimumab, biologic agents, complement, LN, SLE, treatment
- in
- Rheumatology (Oxford, England)
- volume
- 60
- issue
- 9
- pages
- 7 pages
- publisher
- Oxford University Press
- external identifiers
-
- scopus:85116957419
- pmid:33341888
- ISSN
- 1462-0332
- DOI
- 10.1093/rheumatology/keaa796
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: © The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Rheumatology.
- id
- 0c254bf2-9a93-473e-a7ae-333997777a5e
- date added to LUP
- 2021-11-23 15:03:58
- date last changed
- 2024-06-15 21:20:06
@article{0c254bf2-9a93-473e-a7ae-333997777a5e,
abstract = {{<p>OBJECTIVE: In light of reports of de novo LN during belimumab (BLM) treatment, we sought to determine its frequency and contributing or protective factors in a real-life setting. METHODS: Patients with SLE who received BLM between 2011 and 2017 at five European academic practices were enrolled (n = 95) and followed longitudinally for a median time of 13.1 months [interquartile range (IQR): 6.0-34.7]; 52.6% were anti-dsDNA positive, 60.0% had low complement levels, and 69.5% had no renal involvement prior to/at BLM initiation [mean disease duration at baseline: 11.4 (9.3) years]. Age- and sex-matched patients with non-renal SLE who had similar serological profiles, but were not exposed to BLM, served as controls (median follow-up: 132.0 months; IQR: 98.3-151.2). RESULTS: We observed 6/66 cases (9.1%) of biopsy-proven de novo LN (4/6 proliferative) among the non-renal BLM-treated SLE cases after a follow-up of 7.4 months (IQR: 2.7-22.2). Among controls, 2/66 cases (3.0%) of de novo LN (both proliferative) were observed after 21 and 50 months. BLM treatment was associated with an increased frequency and/or shorter time to de novo LN [hazard ratio (HR): 10.7; 95% CI: 1.7, 67.9; P = 0.012], while concomitant use of antimalarial agents along with BLM showed an opposing association (HR: 0.2; 95% CI: 0.03, 0.97; P = 0.046). CONCLUSION: Addition of BLM to standard-of-care did not prevent LN in patients with active non-renal SLE, but a favourable effect of concomitant use of antimalarials was implicated. Studies of whether effects of B-cell activating factor inhibition on lymphocyte subsets contribute to LN susceptibility are warranted.</p>}},
author = {{Parodis, Ioannis and Vital, Edward M. and Hassan, Sabih Ul and Jönsen, Andreas and Bengtsson, Anders A. and Eriksson, Per and Leonard, Dag and Gunnarsson, Iva and Rönnblom, Lars and Sjöwall, Christopher}},
issn = {{1462-0332}},
keywords = {{adverse events; autoantibodies; belimumab; biologic agents; complement; LN; SLE; treatment}},
language = {{eng}},
month = {{09}},
number = {{9}},
pages = {{4348--4354}},
publisher = {{Oxford University Press}},
series = {{Rheumatology (Oxford, England)}},
title = {{De novo lupus nephritis during treatment with belimumab}},
url = {{http://dx.doi.org/10.1093/rheumatology/keaa796}},
doi = {{10.1093/rheumatology/keaa796}},
volume = {{60}},
year = {{2021}},
}