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Effects of belimumab on the lipid profile in systemic lupus erythematosus patients: an observational study
Di Liang1, Shimei Huang1, Rui Ding2
1Department of Rheumatology, Zhongshan Hospital Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China.
Insights
Belimumab treatment significantly increased high-density lipoprotein (HDL) cholesterol in systemic lupus erythematosus (SLE) patients. This improvement in HDL levels correlated with reduced disease activity and may help manage cardiovascular risk in SLE.
Area of Science:
- Rheumatology and Immunology
- Cardiovascular Risk Management in Autoimmune Diseases
Background:
- Systemic lupus erythematosus (SLE) is associated with dyslipidemia and increased cardiovascular risk.
- Belimumab, a biologic therapy, targets B-cell pathways in SLE management.
- The impact of belimumab on lipid profiles in SLE patients requires further investigation.
Purpose of the Study:
- To investigate the effects of belimumab on lipid profiles in patients with systemic lupus erythematosus (SLE).
- To compare lipid profile changes in SLE patients treated with belimumab versus those not receiving the treatment.
- To explore the relationship between lipid level changes, clinical response, and disease activity markers in belimumab-treated SLE patients.
Main Methods:
- Retrospective analysis of 41 SLE patients treated with belimumab for at least 6 months.
- Comparison with a control group of 56 age- and sex-matched SLE patients not on belimumab.
- Longitudinal assessment of lipid profiles (HDL, LDL, triglycerides, ApoA-I, ApoB) and disease activity markers (IgG, anti-dsDNA, C3, SLEDAI-2K) using Generalized Estimating Equation (GEE) analyses.
Main Results:
- Belimumab treatment led to a significant sustained increase in high-density lipoprotein (HDL) cholesterol levels over 6 months (7.6% increase from baseline).
- Significant increases in HDL and apolipoprotein A-I (apoA-I) were observed as early as 1 month into treatment.
- No significant changes were noted in total cholesterol, triglycerides, LDL cholesterol, or apolipoprotein B. HDL increases were associated with reduced disease activity (IgG, anti-dsDNA, C3) and significant only in patients with a clinical response (≥4-point SLEDAI-2K reduction).
Conclusions:
- Belimumab treatment can lead to a significant and sustained improvement in HDL cholesterol levels in SLE patients.
- The observed increase in HDL may be linked to improved control of lupus disease activity.
- This lipid profile modification could potentially contribute to mitigating cardiovascular risk in SLE patients.
Abstract:
This study is asked to investigate the effects of belimumab on the lipid profile in systemic lupus erythematosus (SLE) patients. Forty-one SLE patients who received at least 6 months of belimumab treatment were retrospectively analyzed. The control group consisted of 56 age- and sex-matched lupus patients not treated with belimumab. The changes in lipid profile after a 6-month treatment were compared between the two groups. Generalized estimating equation (GEE) analyses were performed to examine lipid levels longitudinally during the period and the effect of clinical response variables and medication on the lipid profile in the belimumab group. In the belimumab group, high-density lipoprotein (HDL) cholesterol levels increased significantly after the 6-month treatment (P = 0.02). After 1 month, HDL, apolipoprotein A-I (apoA-I) significantly increased by 13.8 and 11.4%, compared with baseline, respectively. After 3 months, HDL and apoA-I increased by 9.0 and 7.1%, respectively. After 6 months, HDL increased by 7.6% compared with baseline. Total cholesterol, triglycerides, low-density lipoprotein cholesterol, and apolipoprotein B did not change significantly over the course of treatment. GEE analyses indicated a significant association between HDL and disease activity indexes, such as IgG, anti-dsDNA, and complement C3. Subgroup analysis revealed significant changes in HDL only in patients who had achieved a ≥ 4-point reduction in SLEDAI-2 K after 6 months of belimumab treatment. Belimumab treatment may result in a long-term increase in HDL level in SLE patients by improving control of lupus activity. This might have beneficial effects on controlling cardiovascular risk in lupus patients. Key Points • Treatment with belimumab resulted in a significant and sustained increase in the HDL levels in SLE patients. • Significant changes in HDL were observed in lupus patients treated with belimumab who had a better clinical response.
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