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- Title
De novo lupus nephritis during treatment with belimumab.
- Authors
Parodis, Ioannis; Vital, Edward M; Hassan, Sabih-Ul; Jönsen, Andreas; Bengtsson, Anders A; Eriksson, Per; Leonard, Dag; Gunnarsson, Iva; Rönnblom, Lars; Sjöwall, Christopher
- 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 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.
- Subjects
EUROPE; AUTOANTIBODIES; LUPUS nephritis; CONFIDENCE intervals; COMPLEMENT (Immunology); CASE-control method; RISK assessment; DESCRIPTIVE statistics; SYSTEMIC lupus erythematosus; ANTIMALARIALS; BELIMUMAB; PHENOTYPES; LONGITUDINAL method; PROPORTIONAL hazards models
- Publication
Rheumatology, 2021, Vol 60, Issue 9, p4348
- ISSN
1462-0324
- Publication type
Article
- DOI
10.1093/rheumatology/keaa796