Ever since the introduction of cyclophosphamide (CY), the management of lupus nephritis has dramatically changed, and its prognosis has greatly improved. Based on randomized controlled trials and long-term observational studies, pulse therapy with CY in combination with methyl-prednisolone (MP) is the "gold standard" of therapy for severe lupus. The realization of the significant gonadal toxicity intensified the efforts for the development of alternative immunosuppressive agents. In a large, randomized controlled trial, newer agents such as mycophenolate mofetil (MMF) have demonstrated comparable efficacy and less toxicity for moderately severe disease. To date, combinations of monthly pulses of CY with MP remain the gold standard for the induction of remission in severe lupus. For maintenance, less toxic agents such as azathioprine or MMF are equally effective and are routinely used in the current therapy of lupus.
BackgroundLow disease activity is a validated target of systemic lupus erythematosus (SLE) therapy.Objectivesτo assess the ability of belimumab to induce low disease activity states in real-life setting.MethodsMulticentre prospective observational study of SLE patients receiving belimumab due to active disease, refractory to at least one conventional immunosuppressant. Disease activity, including attainment of lupus low disease activity state (LLDAS) and remission-on-glucocorticoids (GC) (clinical SLEDAI-2K=0 with prednisone ≤5 mg/day), accrual of organ damage, flares and side effects were documented.ResultsNinety-one patients were included [94.5% women, mean (SD) age 45.9 (12.5) years]. Most frequent manifestations were arthritis (76.7%), rash (72.5%), serologic activity (low C3/C4 and/or high anti-dsDNA; 54.9%), hair loss (47.2%) and mucosal ulcers (27.5%). Median (range) duration of treatment was 10.5 (3.0–42.1) months. Belimumab decreased average SLEDAI-2K, physician global assessment and daily prednisone dose over time, as early as 3 months after initiation. Complete withdrawal of GC was achieved in 17.8%, 22.5%, 31.7% and 23.3% at 3, 6, 9 and 12 months, respectively. The number of flares and severe flares was reduced by 62% and 50%, respectively, during the first year of treatment. Although reduction in clinical SLEDAI-2K was more pronounced in patients who were serologically active (from 8 to 1.5 at 12 months) compared to serologically inactive (from 6 to 4) at baseline, attainment of low disease activity states (LLDAS or remission) did not differ between groups and was reached by more than 40% of completers after 9–12 months (figure 1). Twenty patients (22.0%) discontinued treatment due to inadequate response and two due to side effects potentially related to the drug.ConclusionsBelimumab is efficacious in achieving low disease activity in over 40% of active SLE patients, accompanied by complete GC discontinuation in more than 20%. Serologically active and inactive patients respond equally to the drug.References[1] Franklyn K, et al. Definition and initial validation of a Lupus Low Disease Activity State (LLDAS). Ann Rheum Dis. 2016;75(9):1615–21.[2] Zen M, et al. Prolonged remission in Caucasian patients with SLE: prevalence and outcomes. Ann Rheum Dis. 2015;74(12):2117–22.Disclosure of InterestNone declared
Background:Pregnancy in women with SLE Systematic Lupus Erythematosus (SLE) has been related with adverse events both in the mother and the foetus.1Many studies have reported relapse of the disease during the pregnancy and post-labour, while others have not confirmed this finding.2To this end, most of these results originate from retrospective studies with patients of diverge ethnicities.Objectives:To record the Greek experience with pregnancies in mothers with SLE and their outcomes, as well as the course of the disease during first year post labor.Methods:This is a prospective, multicentre, observation study lasting three years. Women diagnosed with SLE who became pregnant consented to be monitored by their treating Rheumatologist. A structured questionnaire is used for monitoring at the beginning of pregnancy (positive pregnancy test) and at least every 3 months thereafter, depending on the course of the disease and pregnancy, until one year after childbirth.Results:A total 64 women and 81 pregnancies were recorded (1.27 pregnancies per patient). Patient’s age at conception was 32.8 ± 5.9 years (mean ± standard deviation). Thirteen patients (20.3%) had past history of nephritis. Regarding pregnancy outcomes, 62 (76.5%) pregnancies ended in live births, miscarriages during 1st, 2ndand 3rdtrimester occurred in 13 (16%). Six pregnancies were lost to followup. Prematurity occurred in 28 live births (45.1% in total), 26-32w (3.2%), 32-36w (22.5%), <37w (19.3%). No cases of preeclampsia occurred. Mean age of birth36.9 weeksand mean birth weight2750gr.The majority (72.5%) of deliveries were performed by caesarean section. In terms of disease activity, most of the women had mild disease at conception, (SLEDAI-2K: 2.67±2.69) that declined during 1st/2ndpregnancy trimester (SLEDAI-2K:1.91±2.09, 1.70±2.22)) but increased during the 1stand 2ndtrimester post labor (SLEDAI-2K: 2.47±4.29 and 2.52±3.2).Conclusion:This is the first Greek inception cohort with prospective monitoring of pregnant SLE patients. Adverse outcomes occur with prematurity being the most frequent. In our cohort disease activity tends to increase during 1stand 2ndtrimester post-labor without serious relapses. Vigilant monitoring during pregnancy and post-labour is advised.References:[1] Bundhun PK, Soogund MZ, Huang F. Impact of systemic lupus erythematosus on maternal and fetal outcomes following pregnancy: A meta-analysis of studies published between years 2001-2016. J Autoimmun 2017;79:17-27. [https://doi. org/10.1016/j.jaut.2017.02.009] [PMID: 28256367][2] Wei S, Lai K, Yang Z, Zeng K. Systemic lupus erythematosus and risk of preterm birth: a systematic review and meta-analysis of observational studies. Lupus 2017;26:563-71. [https://doi. org/10.1177/0961203316686704] [PMID: 28121241]Acknowledgments:Hellenic Rheumatology AssociationDisclosure of Interests:Stella Ntali: None declared, Lina Pantazi: None declared, Kyriaki Boki: None declared, Dionysis Nikolopoulos: None declared, Antonis Fanouriakis: None declared, Despoina Dimopoulou: None declared, Ioannis Kallitsakis Grant/research support from: MSD, Speakers bureau: Genesis pharma, Bristol-Myers Squibb, CHARALAMPOS PAPAGORAS: None declared, Vasiliki Dania: None declared, Evgenia Emmanouilidou: None declared, George Bertsias Grant/research support from: GSK, Consultant of: Novartis
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.