Background/Purpose: Belimumab is a B lymphocyte stimulator-specific inhibitor approved for treatment of systemic lupus erythematosus (SLE). The purpose of the study was to describe medication use patterns among belimumab users in a commercially insured population.

Methods: This is a retrospective cohort study of newly initiated belimumab users in the HealthCore Integrated Research Database during an intake period of 3/1/2011 through 9/30/2012. Newly initiated belimumab users were defined as those with ≥1 belimumab medical or pharmacy claim within the intake period and without belimumab use prior to index date (i.e., first belimumab claim date in the intake period). Patients were required to have ≥6 months pre- and post- index eligibility and ≥1 SLE diagnosis during the study period of 03/01/2010-09/30/2012. Demographics included age, gender, insurance type, and geographic region. SLE severity and comorbidities were reported in the 6 month pre-index period. Physician specialties associated with belimumab prescriptions in the post-index period were examined. First discontinuation of belimumab use (defined as a gap of >105 days between 2 administrations of belimumab) and concomitant medication use was assessed in the post-index period.

Results: 108 newly initiated belimumab users were identified with a mean age of 44 years, and 93.5% were female. Patients were more concentrated in west region (43.5%) and more were enrolled in preferred provider organization plans (60.2%). 18.5%, 66.7% and 14.8% of patients were categorized as mild, moderate and high SLE severity, respectively. The most prevalent pre-index SLE related comorbidities were cardiac disease (34.3%), hypertension (29.6%), and myositis (26.9%). During the post-index period, 32.4% and 12.0% of patients received belimumab prescriptions from rheumatologists and family/general practitioners/internal medicine physicians, respectively. 42.6% of patients discontinued belimumab use during the follow-up period. The mean [SD] length of belimumab therapy prior to the first discontinuation was 236 [154] days. Among patients who continuously used oral SLE medications prior to the index date, 58.1%, 32.1%, and 30.3% discontinued use of oral steroids, immunosuppressants and antimalarials, respectively within 1 month of belimumab initiation. Additionally, use of SLE medications was found to decrease from the first to sixth month of the post-index period: oral steroids (41.7% vs. 38.0%), immunosuppressants (38% vs. 36.1%) and antimalarials (52.8% vs. 48.2%).

Conclusion: This study described demographics and clinical profiles of newly-initiated belimumab users and utilization of SLE therapies in real-world US settings. Discontinuations of oral steroids, immunosuppressants and antimalarials were observed over 6 months after belimumab initiation. Impact of belimumab use on overall health resource utilization and cost needs further evaluation.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/characteristics-and-medication-use-patterns-among-belimumab-users-in-a-commercially-insured-population-with-systemic-lupus-erythematosus/