Background Current treatments for systemic lupus erythematosus (SLE) include corticosteroids (CS); immunosuppressants (IM); antimalarials (AM); biologics such as belimumab, a monoclonal antibody that inhibits B-lymphocyte stimulator (BLyS) and received approval from the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) in 2011; and rituximab (off-label), a chimeric monoclonal antibody against B-cell CD20.
Objectives To assess the treatment of patients with moderate-to-severe SLE.
Methods Data were extracted from the Adelphi 2010 and 2013 Lupus Disease-Specific Programmes, multinational surveys of clinical practice. Physicians completed Patient Record Forms (PRFs), which included current treatment and treatment history, and underwent face-to-face interviews, which included questions about future treatment intentions. Patient eligibility was determined by physicians; disease activity and severity were based on physician assessment.
Results In 2010, data were collected from rheumatologists in the USA (n=50), France (n=23) and Germany (n=35), including 250/115/175 PRFs, respectively. The 2013 sample consisted of rheumatologists in the USA (n=97), France (n=37) and Germany (n=35), and included 550/200/207 PRFs, respectively. Within the moderate-to-severe SLE population, proportions of patients receiving each treatment class remained similar between 2010 and 2013; the most common being CS and AM (Fig. 1). Barriers to prescription of biologics included safety concerns, expense, and unwillingness of patients to attend infusion centres. In 2013, belimumab uptake was highest in the USA and Germany: treatment in moderate-to-severe patients was 14%/15%/6% in the USA/Germany/France, respectively. In the USA, belimumab was reported as a first-line therapy in 3% patients, and only 50% receiving it had received prior AM, IM and CS treatment (compared with 87% French and 83% German patients). 60% of physicians in the USA and 54% in Germany intended to increase belimumab use over the next 6 months, compared with 81% in France. Most physicians intended to maintain their use of rituximab; 26% of USA and German rheumatologists and 21% of French rheumatologists planned to increase it. Prescription of other treatment classes, including CS and AM, was predicted to remain unchanged.
Conclusions The treatment landscape of moderate-to-severe SLE has remained generally similar since 2010, with CS and AM remaining the dominant treatments despite FDA/EMA approval of belimumab. Belimumab uptake is evident in the US and Germany, but not in France, although a high proportion of physicians intend to increase its use over the next 6 months. In the USA, belimumab is prescribed earlier following diagnosis, sometimes as a first line therapy; use in Europe is later, following standard of care treatments.
Acknowledgements The authors acknowledge Costello Medical Consulting for writing and editorial assistance which was funded by UCB Pharma.
Disclosure of Interest V. Strand Consultant for: UCB Pharma, J. Johnson: None declared, C. Vandeloo Employee of: UCB Pharma, C. Galateanu Employee of: UCB Pharma, S. Lobosco: None declared