Department of Rheumatology, Tohoku University Hospital, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan.
Clin Rheumatol. 2024 Mar;43(3):1023-1035. doi: 10.1007/s10067-024-06904-9. Epub 2024 Feb 9.
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.
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.
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.
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.
动脉粥样硬化是系统性红斑狼疮（SLE）的主要并发症，可由疾病本身、药物毒性和代谢综合征加重。尽管贝利尤单抗（BEL）可改善 SLE 患者的疾病活动度并减少泼尼松龙（PSL）剂量，但对代谢谱的影响尚不清楚。我们旨在评估皮下注射 BEL 对疾病活动度和代谢谱的影响。
共纳入 106 例接受 BEL 皮下注射的 SLE 患者，其中 76 例患者在开始 BEL 治疗至少 1 年后进行评估。回顾性分析了临床信息，包括保留率、疾病活动度、肾脏结局、患者满意度和代谢谱。
2 年后 BEL 的保留率>80%，无效和疼痛是终止 BEL 治疗的主要原因。BEL 组对副作用的满意度高于 PSL 组。BEL 显著改善了疾病活动度、狼疮肾炎和 PSL 剂量，中位数降低了 4mg/天。这些效果在活动期疾病和阳性 C1q 结合免疫复合物中观察到，并且在这些情况下可以实现 PSL 减少≥5mg。PSL 减少≥5mg 的患者的低密度脂蛋白和三酰甘油分别显著降低了 13mg/dL 和 17mg/dL，而 PSL 减少<5mg 的患者则没有变化。
皮下注射 BEL 可有效改善慢性疾病患者的疾病活动度和蛋白尿，同时减少 PSL。BEL 减少 PSL 也改善了血脂状况，这可以协同降低 SLE 的心血管风险。
使用皮下贝利尤单抗的患者观察到疾病活动度、蛋白尿和泼尼松龙显著降低。
与泼尼松龙相比，皮下贝利尤单抗的副作用方面患者满意度更高。
贝利尤单抗减少泼尼松龙有助于改善血脂状况，并降低心血管风险。
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