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LSO-062 Worse outcomes linked to ethnicity for the early treatment of refractory SLE: results from the BILAG-BR
  1. Sarah Dyball1,
  2. Mia Rodziewicz1,
  3. Emily Sutton1,
  4. Ben Parker1,2 and
  5. Ian N Bruce1,2
  1. 1Centre for Musculoskeletal Research, The University of Manchester, UK
  2. 2Kellgren Centre for Rheumatology, Manchester NHS Foundation Trust, UK

Abstract

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.

Abstract LSO-062 Figure 1

Mean SLEDAI-2k at baseline, 3, 6 and 12 months, in A) Rituximab (n=1089), B) Belimumab (n=179) and C) SoC (n=208) treated patients

Abstract LSO-062 Table 1

Demographic and clinical data by ethnic background. EID, English indices of deprivation 2019 decile; SoC, standard of care. Data presented as median (IQR) or N (%), with respective p values computed with chi2 or Kruskall-Wallis test

  • Ethnicity
  • Outcomes
  • Treatment response
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