The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Effect of belimumab in patients with systemic lupus erythematosus treated with low dose or no corticosteroids

  • Yeo-Jin Lee (Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Soo Min Ahn (Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Seokchan Hong (Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ji-Seon Oh (Department of Information Medicine, Big Data Research Center, Asan Medical Center) ;
  • Chang-Keun Lee (Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Bin Yoo (Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yong-Gil Kim (Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2023.05.21
  • Accepted : 2023.07.10
  • Published : 2024.03.01
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Abstract

Background/Aims: Systemic lupus erythematosus (SLE) responder index (SRI)-4 response has been achieved with belimumab treatment in patients with moderate disease activity in cornerstone clinical trials and following studies. However, most studies involved patients treated with a mean prednisolone-equivalent dose of approximately 10 mg/d and focused on the steroid-sparing effect of belimumab. We aimed to identify the effect of belimumab in patients with mild-to-moderate SLE who were treated with low-dose or no corticosteroids. Methods: We retrospectively reviewed the electronic medical records of patients treated with belimumab for at least 6 months between May 2021 and June 2022. The primary endpoint was SRI-4 response at 6 months. Results: Thirty-one patients were included (13 low dose- and 18 steroid non-users). The mean age was 39.2 ± 11.4 years, and 90.3% of patients were female. The baseline Safety of Estrogens in Lupus Erythematosus National Assessment-Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) score was 6.0 (4.0-9.0). The primary endpoint was achieved in 32.3% (10/31) of patients. Significant improvements in anemia, C4 levels, and SELENA-SLEDAI score were observed during treatment. Univariate analysis showed that the baseline SELENA-SLEDAI and arthritis were significantly associated with SRI-4 response at 6 months, and only the SELENA-SLEDAI remained significant (p = 0.014) in multivariate analysis. Conclusions: This cohort study is the first to report the efficacy of belimumab after minimizing the effect of corticosteroids. Belimumab showed efficacy in improving the SELENA-SLEDAI score, anemia, and low C4 in patients who did not receive corticosteroids or received only low doses.

Keywords

Acknowledgement

This work was supported by Asan Institute for Life Sciences, Asan Medical Center (2022IF0013).

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