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Background: Belimumab is an approved biologic therapy for both Systemic Lupus Erythematosus (SLE) and Lupus Nephritis (LN). However, there isn't a clear guidance and when to use Belimumab in the treatment paradigm of systemic Lupus erythematosus. despite the recent update in guidelines. We describe the pattern of treatment of Belimumab in UAE centres to understand the rationale and position of Belimumab in the treatment plan and as real-world evidence from the region of Middle East particularly steroid reduction as one of important target from clinical trials. Objectives: To understand the rationale of rheumatologist in UAE in when to prescribe Belimumab and what is the outcome of their practice. Methods: A multicentre retrospective analysis of the pattern of use of Belimumab in SLE patients in UAE, looking into clinical and serological parameters, indications, and outcomes for a period of 6 months from initiation of treatment. We collected 54 cases from 7 centres. Data sheet case record contains data on demographics (age, sex, ethnic origin), disease activity score (SLEDAI), previous treatment given, Patients global assessment, Serological acitivities like DsDNA, C3, C4, ESR, CRP, also collecting date of length or treatment, progression of disease, any reason of discontinuation. We are presenting the steroid reduction and pattern and improvement of SLEDAI for this period. All data were reviewed by all contributing physicians and agreed on contents and material Results: 54 case records of patients of SLE treated with Belimumab from 7 centres in the UAE. 36 patients are from Middle East (ME) region mainly Arabic, the rest are from South and East Asia and East Africa mainly. Female to male ratio 91/9 % (49/5). Mean age 36.3 (18-67) with age group 31-40 are the highest at 37% and age group 41-50 at 20%. All patients have experienced traditional management of SLE with Hydroxychloroquine and Immunosuppression variably. The mean disease duration is 7.9 years (1-30). The main analysis of the 88% of patients were on steroids divided on the bases of (30mg) Figures 1. finding is that 19% (9) of patients were able to discontinue steroids at 6 months Table 1 1, whilst there was significant reduction of patients on steroid dose more than 15mg from 33% (16) at baseline down to 10% (5) 6 months. The decline was clear by 3 months in most patients. SLEDAI score mean was 11.1 at baseline dropped to 4.43 at six months see Figure 2. cases of discontinuation at 6 months (3.7%) due to lack of efficacy/disease worsening. Conclusion: Our Real-world evidence cohort study has shown significant overall steroids reduction during the 6 months period associated after the initiation of treatment in SLE patients in UAE associated with significant reduction in disease activity score (SLEDAI). Further analysis for a longer course of treatment is required to have better treatment related outcomes or adverse events for establishing regional recommendation for longer use. REFERENCES: 1 Shirley P. Huang, Sonya J. Snedecor, Sakina Nanji, Emily Lloyd, and Christopher F. Bell, Real-World Effectiveness of Belimumab in Systemic Lupus Erythematosus: A Systematic Literature Review, Rheumatol Ther. 2022 Aug; 9(4): 975–991, Published online 2022 May 21. doi: 10.1007/s40744-022-00454-9, PMCID: PMC9314515 2 Myrto Nikoloudaki, Dionysis Nikolopoulos, Sofia Koutsoviti, Irini Flouri, Noemin Kapsala, Argyro Repa, Pelagia Katsimbri, Evangelos Theotikos, Sofia Pitsigavdaki, Katerina Pateromichelaki, Antonios Bertsias, Antonia Elezoglou, Prodromos Sidiropoulos, Antonis Fanouriakis, Dimitrios Boumpas, George Bertsias. Clinical response trajectories and drug persistence in systemic lupus erythematosus patients on belimumab treatment: A real-life, multicentre observational study, Front Immunol. 2023 Jan 4:13:1074044, PMID: 36685524 PMCID: PMC9845912 DOI: 10.3389/fimmu.2022.1074044 Acknowledgements: NIL. Disclosure of Interests: None declared.
Ansari et al. (Sat,) studied this question.