Abstract
Background The efficacy of belimumab in African American (AA) patients has not been clearly proven. Manufacturer recommends use with caution in AA because efficacy in this population has not been well established. We aim to report clinical outcomes and safety of belimumab therapy in our AA population with Systemic Lupus Erythematosus (SLE) at Louisiana State University Health Sciences Center.
Methods This is a single center, descriptive, retrospective case series report. We used electronic medical records to identify AA patients, 18 years or older, diagnosed with seropositive SLE according to SLICC criteria, who had received belimumab in combination with standard therapies. Demographics, comorbidities, clinical outcomes, laboratory outcomes, medication utilization and adverse events are reported.
Results We identified 15 patients who started belimumab from March 2011 to March 2018. Only 5 met our study criteria. All patients were female with a mean age of 41.4 years at belimumab initiation (baseline). The average time since SLE diagnosis at baseline was 13.5 years. The average time on belimumab at the time of analysis was 19.06 months. At baseline, 80% had high dsDNA with 75% showing improvement upon analysis. All patients had low C3 or C4 at baseline and 75% had normalized at time of analysis.
The top 3 reasons for starting belimumab were arthritis/arthralgia in 80% of patients, to decrease use of steroids and serositis, both in 40% of the cases. Eighty percent of patients were using prednisone at baseline. Two of them were concomitantly on hydroxychloroquine (HCQ) and a third one was on HCQ and MMF on top of prednisone. A fourth patient was just on prednisone and the last patient was taking HCQ, MMF and MTX without steroids.
At time of assessment, 1 patient had been weaned off of PDN and another one had reduced the dose by 50%. There was a mean steroid dose reduction of 12.5 mg/day. The other two patients remained at same dose. All patients on HCQ continued on it and the medication was started during the observation period in subject who was not on it. Among patients on MMF, one remained on it at same dose and the other was able to reduce dose by 50%. Arthritis/arthralgia resolved in 3 of 4 patients and serositis resolved in 100% of cases.
Conclusions Belimumab is an excellent steroid sparing agent, with a mean dose reduction of 12.5 mg/day. Belimumab normalized or improved most immunological studies and showed great clinical efficacy. More complex SLE cases show a less robust clinical response. Further assessment of belimumab in the AA population will be required.
Funding Source(s): None.
