Corticosteroid dosing and opioid use are high in patients with SLE and remain elevated after belimumab initiation: a retrospective claims database analysis

Abstract

ObjectivesTo investigate corticosteroid and opioid use among patients with SLE and to examine the impact of belimumab initiation on the use of other SLE therapies.MethodsWe identified adult patients with SLE (International Classification of Diseases, 9th Revision/10th Revision 710.0 and M32) between 1 January 2012 and 31 May 2018 (earliest SLE diagnosis=index date) within MarketScan administrative claims data. Patients were followed from index date for a minimum of 12 months and until the earlier of disenrolment in their health plan or study end (31 May 2018). Corticosteroid utilisation, corticosteroid dose (in prednisone equivalents) and opioid utilisation (overall, by strength (weak, strong) and by duration (chronic use defined as >90 days of cumulative drug supply)) were measured during follow-up. Oral corticosteroid and opioid use were compared in the 6 months before and after initiation of belimumab.ResultsThere were 49 413 patients with SLE eligible for analysis (mean (SD) age: 50.1 (14.0) years, 90.2% female). Of these, 68.5% received corticosteroids, and the average number of prescriptions was 4.59 (4.11) over the first 12 months of follow-up. Among patients with oral corticosteroids, average daily dose was 19.4 (14.2) mg and 59.6% had an average daily dose of ≥15 mg. Half (52.6%) had at least one opioid prescription and of these, 34.6% had chronic use over the first 12 months of follow-up. Among patients initiating belimumab during follow-up (n=1710), oral corticosteroid use decreased by 9.1% (p=0.001), and average daily dose decreased from 14.5 (18.4) mg to 11.9 (18.0) mg (p<0.001) in the 6 months after initiation compared with the 6 months prior. Initiation of belimumab had no impact on prevalence of opioid use.ConclusionsA high proportion of patients with SLE are treated with corticosteroids to control SLE and opioid therapy to manage chronic pain. While there was no change in opioid use, oral corticosteroid use and dose intensity decreased following initiation of belimumab.

Evaluating the Use of Glucocorticoids Among Belimumab‐Treated Patients With Systemic Lupus Erythematosus in Real‐World Settings Using the Rheumatology Informatics System for Effectiveness Registry

“…In contrast, electronic health records (EHRs) provide detailed physician notes on prescribed doses and records of pharmacy‐dispensed prescriptions. Additionally, previous retrospective studies relied on the mean glucocorticoid dose at different time points, limiting the detail available on treatment tapering and treatment of flares ( 7 , 9 , 10 ).…”

10 Years of belimumab experience: What have we learnt?

“…85 In a separate retrospective claims database analysis of patients with SLE (N ¼ 49,413 eligible for analysis), those initiating belimumab during follow-up (n ¼ 1710) significantly decreased their oral corticosteroid use and average daily dose in the 6 months after initiation compared with the 6 months prior to initiation. 86…”

Distinct binding mode of BAFF antagonist antibodies belimumab and tabalumab, analyzed by computer simulation

“…BAFF is a type II transmembrane protein encoded by human chromosome 13q34, which is mainly expressed in peripheral blood mononuclear cells, lymph nodes, spleen, and thymus, but lowly expressed in the small intestine, pancreas, placenta, and lung [10,11]. Abundant evidence demonstrated that BAFF is involved in pathogenesis of systemic lupus erythematosus (SLE), which is a prototype autoimmune disease affecting multiple organ systems [12][13][14][15][16][17][18]. In these patients, a large number of autoantibodies are produced and the deposition of immune complexes occurs in multiple organs, especially in kidneys [19][20][21][22][23][24][25][26].…”

“…Anti-BAFF monoclonal antibody can reduce the elevated levels of immunoglobulin and lupus related damage factors in peripheral blood of SLE patients [48]. Belimumab (also known as Benlysata) is a fully human monoclonal IgG1λ antibody, which can neutralize the soluble BAFF [12,[49][50][51][52][53][54][55]. It was proved by FDA in 2011 as a targeted therapy for SLE [56][57][58].…”