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COVID-19 in Systemic Lupus Erythematosus patients treated with belimumab: a retrospective clinical study

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Abstract

Background

Routine use of immunosuppressive agents in systemic lupus erythematosus (SLE) patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) potentially increases the risk of adverse outcomes. belimumab, a monoclonal antibody for the treatment of SLE, remains untested for its specific impact on coronavirus disease 2019 (COVID-19) symptoms in these patients. Here, this research investigated the effect of belimumab on COVID-19 symptoms in SLE patients infected with SARS-CoV-2.

Methods

This study enrolled SLE patients who underwent treatment with belimumab. After thorough screening based on the inclusion and exclusion criteria, data pertaining to COVID-19 for both the participants and their cohabitants were obtained through telephone follow-up. The potential impact of belimumab on COVID-19 was evaluated by comparing COVID-19 symptoms and medication use across various groups to investigate the association between belimumab treatment and COVID-19 in SLE.

Results

This study involved 123 SLE patients, of whom 89.4% tested positive for SARS-CoV-2. Among cohabitants of SLE patients, the SARS-CoV-2 positive rate was 87.2% (p = 0.543). Patients treated with belimumab exhibited a lower incidence of multiple COVID-19 symptoms than their cohabitating counterparts (p < 0.001). This protective effect was found to be partially related to the time of last belimumab administration. Among those with COVID-19, 30 patients opted to discontinue their anti-SLE drugs, and among them, 53% chose to discontinue belimumab. Discontinuing drugs did not increase the risk of hospitalization due to SARS-CoV-2 infection.

Conclusion

This study concluded that treatment with belimumab did not increase susceptibility to COVID-19 and beneficially alleviated the symptoms of COVID-19.

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Data availability

All data generated or analysed during this study are included in this published article and its supplementary information files.

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Acknowledgements

Not applicable.

Funding

This work was supported by the National Natural Science Foundation of China (82001728), 1·3·5 project for disciplines of excellence, West China Hospital, Sichuan University (Grant Number: ZYGD18015, ZYJC18003) and Medical Research Program of Sichuan Province (S21016).

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Author notes

  1. Yinlan Wu and Yanhong Li authors contributed equally.

Authors and Affiliations

  1. Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China

    Yinlan Wu, Yanhong Li, Tong Wu, Deying Huang, Xiuping Liang, Lu Cheng, Chunyu Tan & Yi Liu

  2. Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China

    Yinlan Wu, Yanhong Li, Tong Wu, Deying Huang, Xiuping Liang, Lu Cheng, Chunyu Tan & Yi Liu

  3. Institute of Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Chengdu, China

    Yinlan Wu, Yanhong Li, Tong Wu, Deying Huang, Xiuping Liang, Lu Cheng, Chunyu Tan & Yi Liu

  4. Central Hospital of Dazhou, Dazhou, China

    Jianhong Wu, Weihua Zhang, Xuejun Jiang & Chaoqiong Yao

  5. Meishan People’s Hospital, Meishan, China

    Zehui Liao & Fang Xu

  6. Department of Medicine 3, Universitäts-klinikum Erlangen, Erlangen, Germany

    Martin Herrmann

  7. Deutsches Zentrum Immuntherapie DZI, Universitätsklinikum Erlangen, Erlangen, Germany

    Martin Herrmann

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  1. Yinlan Wu
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Contributions

All authors contributed to the study conception and design. CYT and YL jointly proposed the study topic and jointly designed the study protocol with YHL. YLW and TW designed the questionnaire and screened the list of potential participants. DYH completed the relevant ethical review. JHW, WHZ, XJJ, and CQY followed up and verified the cohort patients by telephone according to the list and data. ZHL completed the data collation and induction. YLW, XPL, and LC performed the data analysis and interpretation of the results. YLW and YHL wrote the manuscript, and CYT, YL and MH revised the manuscript.

Corresponding authors

Correspondence to Chunyu Tan or Yi Liu.

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Competing interests

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This retrospective study received ethical approval from the Biomedical Ethics Committee of West China Hospital, Sichuan University. The approval number assigned to this study is 2023 (277). This study was a retrospective observational study, without any intervention in the process of patient care, and all data did not contain information that could identify the patient’s identity and would not harm the patient’s privacy, so informed consent was not applicable. The study did not involve animal studies, and no ethical approval was needed.

Ethics declarations

This study was approved by the ethical committee of West China Hospital of Sichuan University (No. 277 in 2023) and complied with the Declaration of Helsinki.

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Wu, Y., Li, Y., Wu, T. et al. COVID-19 in Systemic Lupus Erythematosus patients treated with belimumab: a retrospective clinical study. Immunol Res (2023). https://doi.org/10.1007/s12026-023-09449-2

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