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在临床实践环境中接受贝利尤单抗治疗的系统性红斑狼疮患者中贝利尤单抗的使用、临床结局及糖皮质激素减量:加拿大观察性研究结果

Belimumab use, clinical outcomes and glucocorticoid reduction in patients with systemic lupus erythematosus receiving belimumab in clinical practice settings: results from the OBSErve Canada Study.

作者信息

Touma Zahi, Sayani Amyn, Pineau Christian A, Fortin Isabelle, Matsos Mark, Ecker George A, Chow Andrew, Iczkovitz Sandra

机构信息

Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto Lupus Clinic, EW, 1-412, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.

GlaxoSmithKline Inc., Toronto, ON, Canada.

出版信息

Rheumatol Int. 2017 Jun;37(6):865-873. doi: 10.1007/s00296-017-3682-9. Epub 2017 Mar 9.

Abstract

To describe the characteristics of patients receiving belimumab, overall patterns of systemic lupus erythematosus (SLE) care, clinical outcomes, and changes in glucocorticoid dose following 6 months of therapy with belimumab, and healthcare resource utilization in belimumab users in Canadian clinical practice settings. Retrospective multicenter medical chart review study of adult patients with SLE who were prescribed belimumab as part of usual care and who received ≥8 infusions or 6 months of treatment. Primary endpoints included physician-determined overall clinical improvement from baseline, glucocorticoid use, and physician-determined SLE disease severity at Month 6. In total, 52 patients were included in the study. At belimumab initiation, 5.8/76.9/17.3% of patients had mild/moderate/severe SLE, respectively. Oral glucocorticoids were discontinued in 11.4% of patients and 59.1% received a lower dose at Month 6. At Month 6, 80.8/57.7/17.3% of patients had a physician-determined clinical improvement of ≥20/≥50/≥80%, respectively. Sixteen patients had a SLE Disease Activity Index-2K score at both baseline and Month 6, with a mean improvement of 2.6 ± 5.3 from 8.1 ± 3.2 at baseline. No formal disease assessment tool was utilized for 42.3% of study patients at baseline. This study provides the first real-world insights into belimumab use in Canada. It demonstrates significant reduction or discontinuation of glucocorticoid dose in 70.5% of patients and clinically significant improvement following 6 months' belimumab therapy. The high number of patients with no formal disease activity assessments highlights a key care gap in SLE treatment in the real-world setting.

摘要

描述接受贝利尤单抗治疗的患者特征、系统性红斑狼疮(SLE)整体护理模式、临床结局、贝利尤单抗治疗6个月后糖皮质激素剂量变化,以及加拿大临床实践中使用贝利尤单抗患者的医疗资源利用情况。对成年SLE患者进行回顾性多中心病历审查研究,这些患者在常规护理中被处方使用贝利尤单抗,且接受了≥8次输注或6个月的治疗。主要终点包括医生判定的与基线相比的整体临床改善情况、糖皮质激素使用情况以及第6个月时医生判定的SLE疾病严重程度。该研究共纳入52例患者。开始使用贝利尤单抗时,分别有5.8%/76.9%/17.3%的患者患有轻度/中度/重度SLE。11.4%的患者停用了口服糖皮质激素,59.1%的患者在第6个月接受了更低剂量的糖皮质激素。在第6个月时,分别有80.8%/57.7%/17.3%的患者经医生判定临床改善≥20%/≥50%/≥80%。16例患者在基线和第6个月时均有SLE疾病活动指数-2K评分,平均改善值从基线时的8.1±3.2降至2.6±5.3。42.3%的研究患者在基线时未使用正式的疾病评估工具。本研究首次提供了加拿大使用贝利尤单抗的真实世界见解。研究表明,70.5%的患者糖皮质激素剂量显著减少或停用,贝利尤单抗治疗6个月后临床有显著改善。大量患者未进行正式的疾病活动评估,凸显了现实世界中SLE治疗的一个关键护理缺口。

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