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Analysis of belimumab prescription and outcomes in a 10-year monocentric cohort: is there an advantage with early use?
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  • Published on:
    Is early use of belimumab in systemic lupus erythematosus really advantageous?
    • I Rua-Figueroa, Rheumatologist Consultat University Hospital of Gran Canaria Doctor Negrin

    Dear Editor,

    Tani et al. conducted an interesting retrospective analysis, involving a monocentric cohort of patients with systemic lupus erythematosus (SLE) treated with belimumab (BEL), in an attempt to assess outcomes associated with the “early use” of BEL compared to more routinely used, e.g., after immunosuppressors 1. However, this study displays several types of bias and other limitations, which are not sufficiently discussed by the authors.
    First at all, the term “early use”, such as appears in the title of the original, is a bit confusing, since the duration of the disease was 10.1±8.6 years, without significant differences between the groups under comparison. In fact, the original study by Tani et al. is more focused on naïve immunosuppressors versus non IS-naïve ones. The relatively long duration of the disease in the IS-naïve group strongly suggests that it was composed of non-severe patients. The numerically greater number of nephritis cases in the non IS-naïve group, namely 13/80 (16%) vs 1/22 (8%), though not showing any statistically significant difference, reinforces our hypothesis. In this sense, the variables included in the comparison are not enough to conclude that there were no differences in severity between the two groups, especially in light of the fact that SLEDAI is a poor measure of SLE severity. These features make the groups quite difficult to compare, particularly taking into account the small – in fact, very small – sample size...

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    Conflict of Interest:
    None declared.