Smoking reduces the efficacy of belimumab in mucocutaneous lupus

ABSTRACT

Objectives: Recently, we demonstrated a negative impact of smoking on belimumab efficacy in patients with systemic lupus erythematosus (SLE). Here, we particularly investigated clinical effects of belimumab and a potential impact of smoking in mucocutaneous and articular SLE.

Methods: We surveyed 62 SLE patients treated between 2011 and 2017. Evaluation included the mucocutaneous descriptors of SLEDAI-2K (rash, alopecia, mucosal ulcers; mcSLEDAI-2K), CLASI, the arthritis SLEDAI-2K descriptor (arSLEDAI-2K) and the 28-joint count.

Results: mcSLEDAI-2K and CLASI activity decreased from baseline to month 6 and 12 (P < 0.001 for all). No worsening in CLASI damage was observed. Current or previous smokers displayed a higher probability of unchanged/worsened mcSLEDAI-2K compared to never smokers (OR: 6.4; 95% CI: 1.5–27.4; P = 0.012), also after adjustment for antimalarial agents. arSLEDAI-2K scores had decreased at month 6 (P < 0.001) and 12 (P < 0.001). Likewise, tender and swollen 28-joint counts had improved at month 6 (P = 0.010 and P < 0.001, respectively) and 12 (P = 0.001 for both). We observed no impact of smoking on belimumab efficacy in articular SLE.

Conclusion: We observed a negative impact of smoking on the efficacy of belimumab in mucocutaneous SLE. In contrast, no impact of smoking on belimumab efficacy was seen in patients with articular manifestations.

KEYWORDS:

• Belimumab
• biological agents
• drug efficacy
• rheumatology
• systemic lupus erythematosus

Acknowledgments

We would like to express our gratitude to Eva Jemseby and Julia Norkko (Karolinska), Maria Andersson (Lund), and Marianne Peterson (Linköping) for managing the serum samples. We also thank all participating patients.

Authors’ contributions

Study conception, design and coordination: IP, AG, IG

Acquisition of serum samples and clinical assessment: IP, CS, AJ, AZ, MF, AB, IG

Statistics and interpretation of the results: IP, AG, IG

Manuscript draft: IP, AG, CS, AJ, AZ, MF, AB, IG

All authors read and critically revised the manuscript for intellectual content, approved its final version prior to submission, and agree to be accountable for all aspects of the work.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Availability of data and materials

The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.

Additional information

Funding

The study was supported by grants from the Swedish Research Council, Swedish Rheumatism Association, King Gustaf V’s 80-year Foundation, Swedish Society of Medicine, Professor Nanna Svartz Foundation, Swedish Heart-Lung Foundation, Foundation in memory of Clas Groschinsky, King Gustaf V and Queen Victoria’s Foundation of Freemasons, Region Östergötland and Stockholm County Council, Karolinska Institutet Foundations, the Lund University Medical Faculty Foundation, Alfred Österlund’s Foundation, the Anna-Greta Crafoord Foundation, Greta and Johan Kock’s Foundation, Lund University Hospital, and it was independent of pharmaceutical sponsors.