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Belimumab improves cutaneous lupus erythematosus regardless of systemic lupus

Recent findings show that the B-cell inhibitor belimumab significantly improved cutaneous lupus erythematosus (CLE) whether or not patients also had systemic lupus erythematosus (SLE).

These findings were presented at the American College of Rheumatology’s annual meeting, ACR Convergence 2022, which runs from Nov. 10 to 14, 2022.

After searching more than 700 interventional and observational studies, the investigators identified six blinded interventional studies to include in a meta-analysis. In these six studies, belimumab was compared to the standard of care, such as conventional disease-modifying anti-rheumatic drugs (DMARDs) or prednisone plus hydroxychloroquine. The authors note the six studies were homogenous and had a low risk of bias.

The researchers chose a primary outcome of clinical response at 52 weeks in belimumab users compared to non-users. They defined clinical response as a decrease in skin manifestations from a baseline British Isles Lupus Assessment Group (BILAG) score of A or B to a BILAG score of B-E. The BILAG index is a validated measure of disease activity in SLE.

Investigators calculated the clinical response time and the time to sustained response in belimumab users and non-users as well as calculating the odds of skin flares at one year.

Overall, the findings showed the odds of clinical response at 52 weeks were 44% higher in patients using belimumab. The earliest time a clinical response was seen was 20 weeks after starting belimumab treatment and clinical response peaked at one year.

The patients being treated with belimumab had a 49% lower risk of severe skin flares.

“Our study is the first meta-analysis of belimumab’s efficacy in CLE and highlights that it is an effective adjunct therapy for patients with CLE as a primary manifestation of SLE,” said the study’s lead author Shivani Garg, MD, MS, in a press release. “The study also highlights that belimumab can take at least 20 weeks to achieve a sustained clinical response in patients with CLE, so it should not be prematurely discontinued in these patients.”

Dr. Garg is an Assistant Professor at the University of Wisconsin School of Medicine and Public Health in Madison, Wis.

The study did not examine the comparative efficacy of belimumab in different subtypes of CLE, but Dr. Garg said it “lays a foundation for future studies across CLE subtypes.”


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