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A phase II, randomized, double-blind, placebo-controlled, dose-ranging study of belimumab in patients with active systemic lupus erythematosus
Arthritis Care and Research , 09/01/09

Wallace DJ et al. – Belimumab was biologically active and well tolerated. The effect of belimumab on the reduction of SLE disease activity or flares was not significant. However, serologically active SLE patients responded significantly better to belimumab therapy plus SOC than to SOC alone.

Methods

Patients with a Safety of Estrogens in Lupus Erythematosus: National Assessment (SELENA) version of the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score 4 (n = 449) were randomly assigned to belimumab (1, 4, or 10 mg/kg) or placebo in a 52-week study
Coprimary end points were the percent change in the SELENA-SLEDAI score at week 24 and the time to first SLE flare

Results

Significant differences between the treatment and placebo groups were not attained for either primary end point, and no dose response was observed
Reductions in SELENA-SLEDAI scores from baseline were 19.5% in the combined belimumab group versus 17.2% in the placebo group
The median time to first SLE flare was 67 days in the combined belimumab group versus 83 days in the placebo group
However, the median time to first SLE flare during weeks 24-52 was significantly longer with belimumab treatment (154 versus 108 days)
In the subgroup (71.5%) of serologically active patients (antinuclear antibody titer 1:80 and/or anti-double-stranded DNA [anti-dsDNA] 30 IU/ml), belimumab treatment resulted in significantly better responses at week 52 than placebo for SELENA-SLEDAI score (-28.8% versus -14.2%), physician's global assessment (-32.7% versus -10.7%), and Short Form 36 physical component score (+3.0 versus +1.2 points)
Treatment with belimumab resulted in a 63-71% reduction of naive, activated, and plasmacytoid CD20+ B cells, and a 29.4% reduction in anti-dsDNA titers by week 52. The rates of adverse events and serious adverse events were similar in the belimumab and placebo groups

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