作者
Takehiro Nakai,Sho Fukui,Yukihiko Ikeda,H. Shimizu,Hiromichi Tamaki,Masato Okada
摘要
Belimumab is an effective and safe treatment option for systemic lupus erythematosus (SLE). However, data on treatment cessation are lacking. Thus, we investigated belimumab-free remission in SLE patients. SLE patients receiving belimumab in our institute (May 1, 2013–May 31, 2019) were retrospectively identified using electronic health records. Eligibility criteria included receiving belimumab for > 180 days and discontinuation for any reason. BILAG category A or B in at least one organ system indicated a disease flare. Follow-up monitoring during post-treatment at week 52 identified relapse-free and relapse patients. Thirty-one patients received belimumab, and 8 patients were included. Of the 8 patients, 4 relapsed within 52 weeks. At belimumab discontinuation, relapse-free patients achieved lower SELENA-SLEDAI (1 [IQR, 0–2] vs. 7 [IQR, 5.5–8] (p = 0.03)), received significantly less steroid (prednisolone equivalent, 3.0 mg/day [IQR, 2.8–3.2] vs. 9.5 mg/day [IQR, 7.3–13.3], p = 0.02) than relapse patients, and significantly more relapse-free patients achieved SELENA-SLEDAI less than 4 and received prednisolone less than 5 mg/day than relapse patients. Furthermore, on discontinuation day, relapse-free patients tended to have higher C3 (91.0 mg/dL [IQR, 78.8–102.3] vs. 56.0 mg/dL [IQR, 39.8–73.0], p = 0.15) and C4 levels (22.0 mg/dL [IQR, 19.00–26.00] vs. 11.0 mg/dL [IQR, 6.00–16.00], p = 0.08) and less anti-dsDNA antibody (5.2 IU/mL [IQR, 3.8–7.8] vs. 48.0 IU/mL [IQR, 11.5–137.3], p = 0.08) than relapse patients. Belimumab discontinuation can be considered for patients who achieved good responses. Normalization of complement, anti-dsDNA antibody, SELENA-SLEDAI less than 4, and steroid dosage less than 5 mg/day might be prognostic markers for belimumab-free remission.