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Impact of subcutaneous belimumab on disease activity, patient satisfaction, and metabolic profile in long-lasting systemic lupus erythematosus

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Abstract

Objective

Atherosclerosis is a major complication of systemic lupus erythematosus (SLE) and is exacerbated by the disease itself, drug toxicity, and metabolic syndrome. Although belimumab (BEL) can ameliorate disease activity and reduce prednisolone (PSL) dose in SLE, its effect on metabolic profiles is obscure. We aimed to assess the effects of subcutaneous BEL on disease activity and metabolic profiles.

Methods

A total of 106 patients with SLE who received subcutaneous BEL were included, and 76 patients who started BEL treatment at least 1 year prior were evaluated. Clinical information, including retention rate, disease activity, renal outcome, patient satisfaction, and metabolic profiles, were retrospectively analysed.

Results

The retention rate of BEL was > 80% after 2 years, and ineffectiveness and pain were the major reasons for discontinuation of BEL treatment. Satisfaction with side effects was higher in the BEL group than that in the PSL group. Belimumab significantly improved disease activity, lupus nephritis, and PSL dosage, with a median reduction of 4 mg/day. These effects were observed in active disease and positive C1q-binding immune complex, and PSL reduction ≥ 5 mg was achievable in such cases. Patients with PSL reduction of ≥ 5 mg showed significantly lower blood low-density lipoprotein and triglyceride by 13 and 17 mg/dL, respectively, while those with PSL reduction of < 5 mg remained unaltered.

Conclusion

Subcutaneous BEL was effective in improving disease activity and proteinuria in patients with chronic disease while reducing PSL. Reduction in PSL by BEL also improved lipid status, which could synergistically reduce cardiovascular risk in SLE.

Key Points

• Significant reduction of disease activity, proteinuria, and prednisolone was observed in patients using subcutaneous belimumab.

• Patient satisfaction was higher in terms of side effects in subcutaneous belimumab compared with prednisolone.

• Reduction in prednisolone by belimumab contributed to the improvement of lipid status and would reduce the cardiovascular risk.

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Data availability

The data underlying this article will be shared upon reasonable request from the corresponding author.

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Acknowledgements

The authors thank the staff of the Department of Rheumatology, Tohoku University Hospital, for their helpful discussions

Funding

This work was partly supported by JSPS KAKENHI Grant Number 21K08469T and the JCR Grant for Promoting Research for D2T RA, which are also associated with open-access initiatives.

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  1. Department of Rheumatology, Tohoku University Hospital, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan

    Maya Yamato, Tsuyoshi Shirai, Yusho Ishii, Hiroko Sato, Tomonori Ishii & Hiroshi Fujii

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Contributions

MY and TS had full access to all data in the study and took responsibility for the integrity and accuracy of the data analysis. Concept and design: MY and TS. Acquisition, analysis, or interpretation of data: all authors. Manuscript drafting: MY. Critical revision of the manuscript for intellectual content: all authors. Statistical analysis: all authors. Obtained funding: TS. All the authors contributed to the manuscript and approved the submitted version.

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Correspondence to Tsuyoshi Shirai.

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The study protocol complied with the principles of the Declaration of Helsinki and was approved by the Ethics Committee of Tohoku University Graduate School of Medicine (reference number: 2022–1-775). Written informed consent was not required because of the retrospective observational nature of the study.

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Yamato, M., Shirai, T., Ishii, Y. et al. Impact of subcutaneous belimumab on disease activity, patient satisfaction, and metabolic profile in long-lasting systemic lupus erythematosus. Clin Rheumatol 43, 1023–1035 (2024). https://doi.org/10.1007/s10067-024-06904-9

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