Session Information
Date: Sunday, November 8, 2015
Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment Poster Session I
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose:
Patient and physician treatment satisfaction influences
long-term adherence with a treatment regimen. The primary objective was to
identify factors linked to satisfaction with the use of belimumab
in clinical practice, in the United States (US). Understanding the impact of belimumab on clinical and patient outcomes was a secondary
objective.
Methods:
The Adelphi Lupus Plus
Project (GSK study 202146) involved US rheumatologists (n=70) who completed
paper-based data collection forms for five consecutive, eligible patients. Patients
were ≥18 years old, diagnosed with SLE
for ≥6 months, and receiving
intravenous belimumab
plus standard SLE care for ≥3months.
Each rheumatologist only included one patient who had received belimumab for 3-6 months. The Western Institutional Review
Board granted an IRB exemption for this study.
Results:
The belimumab cohort (n=376)
was 95% female, mean age 42, and Caucasian (56.1%) or African American (27.1%).
Mean time since SLE diagnosis was 7 years and mean time treated with belimumab was 13 months, 65% were employed
or were students. The majority of patients had disease involving both skin and
joints (64%); 19.8% had only joint involvement. Prior to adding belimumab,
most had ‘moderate’ (60%) or ‘severe’ (24%) disease and disease that was “deteriorating” (85%).
The patient self-completion form was
completed by 72% of patients (n=270). The majority of patients (86%) reported a
level of satisfaction with belimumab; 28% were ‘very
satisfied’, 32% ‘satisfied’ and 26% were ‘somewhat satisfied’. Most physicians
were satisfied with belimumab (83%). Concordance
between physician and patient satisfaction was moderate (Kappa Score = 0.4541). Predefined, multivariate analysis
identified factors strongly associated with satisfaction (Table 1).
|
Table SEQ Table * ARABIC 1. Multivariate analyses identified factors associated with patient and physician satisfaction with beliumumab. Factors reported by the patient are denoted by (Pt) and by the Rheumatologist (Rh) |
|
|
OR (95% CI)
|
|
|
PATIENT SATISFACTION
|
|
|
Patient satisfaction is associated with:
|
|
|
Improved ability to engage in leisure activities (Pt) |
4.66 (2.12 -10.25) |
|
Reduction in fatigue severity (Rh)
|
3.72 (1.77 -7.79) |
|
General symptom improvement (Pt) |
3.02 (1.15 – 7.94) |
|
Improvement in pain/achiness (Pt) |
2.71 (1.12 – 6.52) |
|
Satisfaction with time taken to receive belimumab (Pt)
|
2.69 (1.40 – 5.15) |
|
Satisfaction with frequency of belimumab (Pt)
|
1.94 (1.04 -3.62) |
|
Patient dissatisfaction is associated with: |
|
|
More severe disease prior to belimumab (Rh)
|
0.36 (0.14 -0.92) |
|
Current use of immunosuppressants (Rh)
|
0.40 (0.19 – 0.84) |
|
RHEUMATOLOGIST SATISFACTION |
|
|
Physician satisfaction is associated with:
|
|
|
Improvement in pain/achiness (Pt) |
6.16 (2.20 – 17.24) |
|
Satisfaction with frequency of belimumab (Pt)
|
3.91 (2.02 – 7.56) |
|
Reduction in fatigue severity (Rh)
|
3.76 (1.93 – 7.35) |
|
Physician dissatisfaction is associated with: |
|
|
Disease classed as currently ‘deteriorating or unstable ‘ (Rh)
|
0.13 (0.06 – 0.26) |
|
Disease not classed as currently ‘mild’ (Rh)
|
0.29 (0.13 – 0.63) |
|
Improved ability to remember things (Pt)
|
0.43 (0.22 – 0.87) |
|
Current use of immunosuppressants (Rh)
|
0.46 (0.26 – 0.83) |
|
Higher numbers of flares in last 12 months (Rh)
|
0.75 (0.63 – 0.91) |
|
|
|
Patient satisfaction was higher for those treated
with belimumab for > 6 months, versus 3-6 months. For
the majority of patients, physicians reported an improvement in overall symptoms
(89%), reduction in flare severity (75%) and flare frequency (75%) since
starting belimumab. Patients themselves stated an
improvement in overall symptoms (89%), fatigue (83%), and pain (83%). Patients
also reported improvements in feeling rested upon waking (91%), improved concentration
(59%), and work (52%), as well as an improved ability to engage in leisure
activities, daily activities and caring for children.
Conclusion:
Adding belimumab improved
symptoms of fatigue and pain and both factors were positively associated with
patient and physician satisfaction. Improvement
in the ability to engage in leisure activities and general symptom improvement were
strongly associated with higher patient satisfaction. This insight into satisfaction
should enhance the dialog between physicians and their patients about the
outcomes expected during belimumab initiation; in
turn, this may improve adherence.
To cite this abstract in AMA style:
Pascoe K, Lobosco S, Bell D, Hoskin B, Ramachandran S, Pobiner B, Chang D. Satisfaction and Impact Associated with the Addition of Belimumab to Systemic Lupus Erythematosus (SLE) Treatment: A Cross-Sectional Survey of US Rheumatologists and Their Patients [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/satisfaction-and-impact-associated-with-the-addition-of-belimumab-to-systemic-lupus-erythematosus-sle-treatment-a-cross-sectional-survey-of-us-rheumatologists-and-their-patients/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/satisfaction-and-impact-associated-with-the-addition-of-belimumab-to-systemic-lupus-erythematosus-sle-treatment-a-cross-sectional-survey-of-us-rheumatologists-and-their-patients/