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Achieving lupus low-disease activity and remission states under belimumab in refractory systemic lupus erythematosus: time and organ involvement matter
  1. Nabiha Sbeih1,
  2. Alexis Mathian1,
  3. Marc Pineton de Chambrun1,
  4. Raphael Lhote1,
  5. Noël Zahr2,
  6. Micheline Pha1,
  7. Fleur Cohen-Aubart1,
  8. Julien Haroche1,
  9. Miguel Hié1,
  10. Sophie Jouffroy3,
  11. Neila Benameur4,
  12. Hervé Devilliers5,
  13. Zahir Amoura1
  1. 1French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Service de Médecine Interne 2, Institut E3M, Inserm, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), Sorbonne Université, AssistancePublique–Hôpitaux de Paris, Groupement Hospitalier Pitié–Salpêtrière, Paris, France
  2. 2Service De Pharmacologie, Assistance Publique–Hôpitauxde Paris, Groupement Hospitalier Pitié–Salpêtrière, Paris, France
  3. 3École Nationale Vétérinaire De Toulouse, Toulouse, France
  4. 4Service De La Pharmacie, Assistance Publique–Hôpitaux de Paris, Groupement Hospitalier Pitié–Salpêtrière, Paris, France
  5. 5Service De Médecine Interne et Maladies Systémiques (médecine interne 2) et Centre d’Investigation Clinique, Inserm CIC 1432, Centre Hospitalier Universitaire de Dijon, Hôpital François-Mitterrand, Dijon, France
  1. Correspondence to Dr Alexis Mathian, Service de Médecine Interne 2, Hôpital Pitié–Salpêtrière, Paris, France; alexis.mathian{at}aphp.fr

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We read with much interest the contribution of Oon et al1 that was published recently in Annals of the Rheumatic Diseases, describing attainment of the lupus low-disease activity state (LLDAS) in a post-hoc analysis of the BLISS trials. At week 52, LLDAS was reached by 12.5% and 14.4% of patients treated with belimumab 10 mg/kg in BLISS-52 and BLISS-76, respectively. The authors conclude that LLDAS is a potential response indicator for future systemic lupus erythematosus (SLE) trials. As opposed to SLE responder index 4 (SRI4),2 which represents a change from baseline activity, LLDAS3 and remission4 are clinical states that should be targeted as they are associated with damage accrual reduction and include the notion of a low prednisone dose.5 Yet, these indicators should be further studied before being introduced into clinical trials. In particular, Oon et al’s study lacks data on the time needed to achieve LLDAS and the clinical factors influencing its achievement. It is also important to consider the absence of relapse after an improvement of the disease. In this letter, we wish to provide additional data on the time needed, the probability of and the clinical predictors for achieving stable (ie, without subsequent relapse until month 12) LLDAS and remission state under belimumab. We included all patient with SLE treated with belimumab (intravenous 10 mg/kg on day 0, 14, 28 and then every 28 days) in our centre from March 2013 to May 2018 for an active disease despite standard therapy. Follow-up was …

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