Why carry out this study?

Belimumab, a human IgG1λ monoclonal antibody, has shown robust efficacy and tolerability in treating systemic lupus erythematosus (SLE) in clinical trials and real-world data.

The 2023 EULAR SLE treatment recommendations suggest early consideration of belimumab, with or without immunosuppressants, after inadequate response to antimalarials and oral glucocorticoids.

However, limited data are available on outcomes for patients initiating belimumab before or after immunosuppressant use.

This study described clinical outcomes in patients initiating belimumab before and after immunosuppressant use within the 24 months before belimumab initiation in a real-world setting.

What was learned from this study?

Patients initiating belimumab before immunosuppressant use had earlier oral glucocorticoid tapering, fewer flares, and longer time to new organ damage than those initiating belimumab after immunosuppressant use.

These results suggest that initiating belimumab before immunosuppressant use may have more favorable outcomes compared with initiating belimumab after immunosuppressant use, supporting its earlier use in the SLE treatment pathway.

Future research should compare the effectiveness of belimumab when initiated at different stages of the treatment pathway, considering potential differences in patient characteristics at initiating therapy.