Background/Purpose: To evaluate the efficacy of belimumab on different skin and joint manifestations of the disease in a multicenter, nationwide, cohort (BeRLISS-NeJS) of patients with systemic lupus erythematosus (SLE).

Methods: In this retrospective observational study, we stratified adult SLE patients treated with belimumab (10 mg/kg/month EV or 200 mg/week SC) based on the joint (nondeforming non-erosive arthritis -NDNE-, Jaccoud’s arthropathy and rhupus) and skin phenotype (acute, subacute, chronic, cutaneous vasculitis, alopecia/lupus hair livedo reticularis) at belimumab initiation. We analyzed the variation of DAS28, CLASI-A, CLASI-D scores, achievment of DAS28 remission (DAS28< 2.6) and CLASI-A remission (CLASI-A=0) at baseline, 12, 24, 36 months of follow-up. Parametric and nonparametric tests were used according to the data distribution.

Results: A total of 443 patients was enrolled (F=394; 88.9%); mean age at diagnosis 29.9±13.2 years, mean treatment duration 31.6±20.8 months. At belimumab initiation 272 patients had joint manifestations (61.4%): 221 NDNE (50.7%), 30 Jaccoud’s arthropathy (6.9%) and 21 rhupus (4.8%); 231 patients (52.1%) had skin manifestations: 112 acute (25.9%), 54 subacute (12.5%) and 18 chronic cutaneous lupus (4.2%), 48 cutaneous vasculitis (11.1%), 23 livedo reticularis (5.3%), 79 alopecia/lupus hair (18.2%).

DAS28 and CLASI-A scores decreased from baseline at 12, 24, and 36 months in all phenotypes (Figure 1).

A statistically significant decrease in DAS28 compared with baseline was observable at 6 months for NDNE (p< 0.001), Jaccoud’s arthropathy (p=0.005) and rhupus (p=0.011). Significant further improvement of DAS28 in patients with NDNE was also observable when comparing DAS28 at 6 vs 12 months (p=0.046) (Table 1). 

A statistically significant decrease in CLASI-A from baseline was observed as early as 6 months for the acute (p< 0.001) and subacute phenotype (p< 0.001), as late as 12 months for the chronic one (0-6 months p = 0.297, 0-12 months p=0.003, data not shown) and as late as 18 months for livedo reticularis (0-12 months p=0,066, 0-18 months p=0,027, data not shown) (Table 1). No significant decrease in CLASI-A was found for the other nonspecific skin manifestations of SLE.

CLASI-D scores remained stable at 36 months compared with baseline for all specific skin phenotypes (p=0.508, p=1.000, p=0.770, respectively). 

DAS28 remission was more frequent in patients with NDNE than Jaccous’s and rhupus subtype at 6 and 36 months; on the other hand, CLASI-A remission was more frequent in patients with acute than subacute and chronic phenotype at 18, 24 and 36 months (Table 2).

Conclusion: Belimumab was effective at reducing joint involvement activity with significant decrease in DAS28 being observable as early as 6 months from treatment start across all joint phenotypes. Significant CLASI-A reduction was achieved later (12 months) in patients with chronic skin involvement than those with acute and subactute phenotypes. CLASI-D stability hints at a lessened damage accrual over the span of 36 months across all skin specific phenotypes. Patients with NDNE arthritis and acute skin subtype achieve more frequently DAS28 and CLASI-A remission than those with other phenotypes.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/efficacy-of-belimumab-on-different-phenotypes-of-joint-and-skin-manifestations-of-systemic-lupus-erythematosus-preliminary-data-from-a-multicenter-nationwide-cohort-of-patients-the-belimumab-in-re/