Real-world experience with personalised belimumab spacing in sustained SLE remission: a multicentre study

Area of Science:

• Rheumatology
• Immunology
• Pharmacology

Background:

• Systemic lupus erythematosus (SLE) is a chronic autoimmune disease.
• Belimumab is a biologic therapy used to treat SLE.
• Long-term remission in SLE patients on belimumab raises questions about optimal dosing strategies.

Purpose of the Study:

• To assess the feasibility and safety of reducing belimumab dosage (spacing) and discontinuing the medication in SLE patients who have achieved long-standing remission.
• To identify patient characteristics associated with successful belimumab dose reduction or withdrawal.

Main Methods:

• A retrospective study identified SLE patients from four centers who underwent belimumab dose spacing or discontinuation.
• The step-down strategy involved gradually increasing the interval between belimumab doses (subcutaneous or intravenous).
• SLE flares were monitored as the primary endpoint during follow-up.

Main Results:

• Of 152 SLE patients, 22 (14.5%) underwent belimumab spacing. These patients had longer remission durations, less serological activity, lower disease activity scores, and were less likely to be on glucocorticoids or other immunosuppressants.
• During a mean follow-up of 21 months, no SLE flares occurred in the spacing group.
• Seven patients eventually discontinued belimumab without requiring dose escalation or increased frequency.

Conclusions:

• Progressive belimumab dose spacing and withdrawal appear feasible and safe for selected SLE patients in sustained remission.
• This strategy is suitable for patients on minimal glucocorticoid doses, without additional immunosuppressants, and with low serological activity.
• Clinical monitoring is crucial for managing belimumab dose adjustments in SLE patients.