Early belimumab accelerates renal response and reduces glucocorticoid exposure in lupus nephritis: a multicentre propensity-matched study.
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Gatto Mariele, Cruciani Claudio, Calatroni Marta, Binda Valentina, Furlan Claudia, Uzzo Martina, Bellis Elisa, Bartoloni Elena, De Angelis Rossella, Salvarani Carlo, Tani Chiara, Mosca Marta, Emmi Giacomo, Adami Giovanni, Caroti Leonardo, Fredi Micaela, Esposito Pasquale, Negrini Simone, Piga Matteo, Cauli Alberto, Conti Fabrizio, Bortoluzzi Alessandra, Montecucco Carlomaurizio, Faggioli Paola, Moroni Luca, Gallina Gabriele, Santoro Domenico, Iagnocco Annamaria, Allinovi Marco, Fenaroli Paride, Lo Gullo Alberto, Iaccarino Luca, Sinico Renato Alberto, Doria Andrea, Moroni Gabriella
Аннотация
METHODS: Consecutive adult patients with biopsy-proven LN treated with belimumab plus SoC as initial therapy were enrolled from Italian lupus referral centres and compared with a historical SoC cohort (1990-2016). Data were collected at baseline and during follow-up. Propensity score matching based on baseline proteinuria, estimated glomerular filtration rate, standard initial treatment and histological class led to comparable groups. Complete renal response (CRR) was defined per 2019 EULAR/EDTA. Cox regression was used to assess predictors.
RESULTS: Ninety-one belimumab patients were matched to 91 SoC patients. At 6 months, CRR was higher in the belimumab group (35.9% vs 16.5%, odds ratio [95% CI]: 2.81 [1.30, 6.29], P = 0.005), while response rates at 12 months were similar (P = 0.87). Time-to-CRR was shorter with belimumab (median [interquartile range] 5.64 [4.08, 7.80] vs 7.92 [5.28, 11.04] months, P < 0.01). At CRR, GC dose was lower in the belimumab group (5 [5-15] vs 15 [10-20] mg/day, P = 0.018). Independent predictors of earlier CRR were baseline proteinuria (hazard ratio per g/24 h increase [95% CI]: 0.89 [0.80, 0.98], P = 0.019) and belimumab use (1.70 [1.11, 2.62], P = 0.016).
CONCLUSION: Early belimumab combination therapy accelerates CRR and reduces GC exposure. Achieving early CRR with lower GC is a key target to limit kidney and GC-related damage, supporting early belimumab integration in LN management.