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2017 ; 26
(14
): 1483-1490
Nephropedia Template TP
gab.com Text
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English Wikipedia
A randomized, open-label study to investigate the effect of belimumab on
pneumococcal vaccination in patients with active, autoantibody-positive systemic
lupus erythematosus
#MMPMID28467293
Chatham W
; Chadha A
; Fettiplace J
; Kleoudis C
; Bass D
; Roth D
; Gordon D
Lupus
2017[Dec]; 26
(14
): 1483-1490
PMID28467293
show ga
Objective Intravenous belimumab 10?mg/kg is approved as an add-on therapy in
patients with active, autoantibody-positive systemic lupus erythematosus. This
study aimed to assess the impact of belimumab on immune response to pneumococcal
vaccination in patients with systemic lupus erythematosus. Methods This was a
Phase 4, open-label study (GSK BEL115470; NCT01597492) conducted in the United
States. Patients were randomized (7:9) to receive a 23-valent pneumococcal
vaccination four weeks prior to (pre-belimumab cohort) or 24 weeks after
(belimumab-concurrent cohort) commencing four-weekly belimumab 10?mg/kg
intravenous treatment plus standard systemic lupus erythematosus therapy.
Analyses of vaccine titers were performed on the as-treated population (received
?1 dose of belimumab). The primary endpoint was the proportion of patients with
positive antibody responses (?2-fold increase from pre-vaccination levels, or
post-vaccination level???0.6?µg/mL if pre-vaccination levels were unquantifiable)
to ?1 of 23 pneumococcal vaccine serotypes, four weeks post vaccination. Other
endpoints included the proportion of patients with positive antibody responses to
?2 to ?10, and ?11-23 (post hoc analysis) of serotypes. Safety was assessed by
monitoring adverse events. Results Seventy-nine patients received pneumococcal
vaccination (pre-belimumab cohort, n?=?34; belimumab-concurrent cohort, n?=?45).
The majority (87.3% [69/79]) completed the study; 10 (12.7%) withdrew (patient
request, n?=?3; adverse event, n?=?3; lost to follow-up, n?=?2; other, n?=?2). At
Week 4 post-vaccination, 97.0% (32/33) and 97.6% (40/41) of patients
(pre-belimumab and concurrent belimumab cohorts, respectively) had a positive
response to ?1 of 23 pneumococcal serotypes. Over 85% of patients in both cohorts
responded to ?10 of serotypes, approximately 80% responded to ?12 serotypes, and
approximately two-thirds responded to ?16 serotypes. Little difference was
observed between cohorts across a broad response, up to 23 serotypes. Eight
(23.5%) patients experienced an adverse event considered by the investigator to
be treatment-related in the pre-belimumab cohort and four (8.9%) in the
belimumab-concurrent cohort; seven patients experienced non-fatal serious adverse
events (pre-belimumab cohort, 11.8% [ n?=?4]; concurrent-belimumab cohort, 6.7% [
n?=?3]), and no deaths were reported. Conclusion The proportion of patients
generating a response to ?1 pneumococcal serotype did not differ between the
pre-belimumab and belimumab-concurrent cohorts; the proportions were also
comparable across a broader response (from ?2 serotypes to 23 serotypes).