Background SLE more commonly affects non-White populations who suffer higher disease activity and damage accrual. We aimed to describe differential response of moderate-to-severe SLE by ethnic group.
Methods Patients commencing rituximab (RTX), belimumab or a standard-of-care medication (SoC) for SLE in the BILAG-BR were analysed over 12-months. Major clinical response (MCR) was defined as a SLEDAI-2K ≤4 at 12 months. Deprivation was measured using English indices of deprivation-2019 decile (EID, 1= most deprived, 10=least). MCR was compared using multivariate logistic regression (adjusted for age, gender and EID).
Results 1601 SLE patients commenced therapy from Sept-2010-Sept-2022 (RTX: N=1177, belimumab: N=193, SOC: N=231). 905 (56.5%) were White, 233 (14.6%) were Black, 197 were Indo-Asian, 81 (5.1%) were Chinese/East Asian, and 60 were of mixed background and 125 (7.8%) preferred not to say (table 1).
MCR was achieved in 901 (56.3%) patients at 12 months. Black patients had a higher SLEDAI-2K at baseline compared with White individuals (figure 1). Black, East-Asian/Chinese patients, and Multiple-Mixed ethnic background patients received higher GC doses at baseline. Black, Indo-Asian and Multiple-Mixed ethnicity patients were more likely to be in a lower EID.
In patients receiving RTX, Black (adjusted OR 0.36 [95%CI 0.25–0.52]) and Indo-Asian (0.42 [0.18–0.96]) patients were less likely to achieve MCR. In patients receiving belimumab, Black (0.65 [0.44–0.96]) and Indo-Asian patients (0.29 [0.09–0.93]) were also less likely to have MCR. Absolute reduction in SLEDAI-2K was similar for each ethnic group.
Conclusions Although absolute reduction in disease activity was similar across ethnic backgrounds, obtaining a MCR following treatment was lower in Black and Indo-Asian patients, in part reflecting higher baseline disease activity, but not explained by level of social deprivation; an observation not confined to a single treatment. There is a need for investigation into the drivers of these inequitable outcomes and reappraisal of treat-to-target strategies in these populations.
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