Dr. Stohl has received consultant fees, speaking fees, and/or honoraria (less than $10,000) from Human Genome Sciences.
Systemic Lupus Erythematosus
A phase II, randomized, double-blind, placebo-controlled, dose-ranging study of belimumab in patients with active systemic lupus erythematosus†
Version of Record online: 27 AUG 2009
Copyright © 2009 by the American College of Rheumatology
Arthritis Care & Research
Volume 61, Issue 9, pages 1168–1178, 15 September 2009
How to Cite
Wallace, D. J., Stohl, W., Furie, R. A., Lisse, J. R., McKay, J. D., Merrill, J. T., Petri, M. A., Ginzler, E. M., Chatham, W. W., McCune, W. J., Fernandez, V., Chevrier, M. R., Zhong, Z. J. and Freimuth, W. W. (2009), A phase II, randomized, double-blind, placebo-controlled, dose-ranging study of belimumab in patients with active systemic lupus erythematosus. Arthritis & Rheumatism, 61: 1168–1178. doi: 10.1002/art.24699
ClinicalTrials.gov identifier: NCT00071487.
- Issue online: 27 AUG 2009
- Version of Record online: 27 AUG 2009
- Manuscript Accepted: 12 MAY 2009
- Manuscript Received: 21 OCT 2008
- The General Clinical Research Center at the University of Southern California Keck School of Medicine, Los Angeles, California
- NIH. Grant Number: M01-RR00043
To assess the safety, tolerability, biologic activity, and efficacy of belimumab in combination with standard of care therapy (SOC) in patients with active systemic lupus erythematosus (SLE).
Patients with a Safety of Estrogens in Lupus Erythematosus: National Assessment (SELENA) version of the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score ≥4 (n = 449) were randomly assigned to belimumab (1, 4, or 10 mg/kg) or placebo in a 52-week study. Coprimary end points were the percent change in the SELENA–SLEDAI score at week 24 and the time to first SLE flare.
Significant differences between the treatment and placebo groups were not attained for either primary end point, and no dose response was observed. Reductions in SELENA–SLEDAI scores from baseline were 19.5% in the combined belimumab group versus 17.2% in the placebo group. The median time to first SLE flare was 67 days in the combined belimumab group versus 83 days in the placebo group. However, the median time to first SLE flare during weeks 24–52 was significantly longer with belimumab treatment (154 versus 108 days; P = 0.0361). In the subgroup (71.5%) of serologically active patients (antinuclear antibody titer ≥1:80 and/or anti–double-stranded DNA [anti-dsDNA] ≥30 IU/ml), belimumab treatment resulted in significantly better responses at week 52 than placebo for SELENA–SLEDAI score (−28.8% versus −14.2%; P = 0.0435), physician's global assessment (−32.7% versus −10.7%; P = 0.0011), and Short Form 36 physical component score (+3.0 versus +1.2 points; P = 0.0410). Treatment with belimumab resulted in a 63–71% reduction of naive, activated, and plasmacytoid CD20+ B cells, and a 29.4% reduction in anti-dsDNA titers (P = 0.0017) by week 52. The rates of adverse events and serious adverse events were similar in the belimumab and placebo groups.
Belimumab was biologically active and well tolerated. The effect of belimumab on the reduction of SLE disease activity or flares was not significant. However, serologically active SLE patients responded significantly better to belimumab therapy plus SOC than to SOC alone.