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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Belimumab &#40;BLM&#41;&#44; a soluble human monoclonal antibody which inhibits the stimulator factor of lymphocyte B &#40;BLyS&#41;&#44; is the only biologic drug approved for the treatment of system lupus erythematosus &#40;SLE&#41;&#46; It is recommended in patients with active SLE &#40;excluding patients with severe renal compromise or compromise of the central nervous system&#41;&#44; with positive antibodies and high grade disease activity despite standard treatment&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We now present the clinical experience of BLM use in a regional hospital servicing a population of 165&#44;000 inhabitants&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Eleven patients with SLE who had received BLM at some time were included&#46; One hundred per cent were female&#44; with a mean age at lupus diagnosis of 31&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;7 years&#46; Regarding clinical manifestations that presented during the course of the disease&#44; joints were most commonly affected &#40;100&#37;&#41;&#44; followed by cutaneous &#40;81&#37;&#41;&#44; haematological &#40;64&#37;&#41;&#44; renal &#40;27&#37;&#41;&#44; pulmonary &#40;9&#37;&#41; and cardiac &#40;9&#37;&#41; manifestations&#46; One hundred per cent of patients presented positivity for antinuclear antibodies&#44; with 27&#37; being positive for anti-DNA native antibodies&#44; 45&#37; for anti-SSA antibodies and 36&#37; for anti-SSB antibodies&#46; 45&#37; of patients presented with positivity for antiphospholipid antibodies and over one third presented with hypocomplementemia&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Regarding treatments prior to the initiation of BLM&#44; 100&#37; of patients had received antimalarial drugs&#44; over 80&#37; methotrexate and 27&#37; azathioprine&#46; Twenty seven per cent had received anti-TNF drugs&#44; 18&#37; cyclophosphamide and 18&#37; leflunomide&#46; One of the patients had received treatment with tacrolimus and rituximab&#46; The mean age of the patients at treatment initiation with BLM was 38&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;6 years&#46; The main manifestations for which treatment was prescribed were joint symptoms followed by cutaneous symptoms&#46; Over 60&#37; of patients underwent an improvement of cutaneous and joint symptoms&#44; with no resolution of lymphopenia being observed in our patients&#46; In 4 of them &#40;37&#37;&#41;&#44; treatment was suspended due to ineffectiveness after a median duration of 12&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;3 months&#46; Particular mention is of one patient who developed a type IV lupus nephritis during treatment&#46; Treatment was not definitively suspended due to side effects in any cases but was temporarily suspended in one patient &#40;9&#37;&#41; due to a respiratory infection&#46; With regard to concomitant treatments&#44; in 3 of them &#40;27&#37;&#41; treatment with BLM led to reduced doses of concomitant treatment &#40;methotrexate&#44; mycophenolate&#41; and it was not possible to assess the possible corticoid sparing effect given the retrospective nature of the study&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">There have been several reports of patient cohorts in U&#46;S&#46;A&#46;&#44; Canada and Germany<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#8211;3</span></a> treated with BLM with favourable results on the reduction of activity&#44; improvements in lab tests and steroid sparing&#46; However&#44; few data on clinical practice is available in Mexico&#46; The OBSERVE<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> study which included 64 patients with SLE&#44; showed an improvement of &#8805;20&#37;&#44; &#8805;50&#37;&#44; &#8805;80&#37; in 72&#37;&#44; 52&#37; and 27&#37; of cases&#44; respectively&#46; The BIOGEAS<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> study which included 10 patients with SLE refractory to antimalarial drugs and at least one other immunosuppressant&#44; where manifestations of BLM were mucocutaneous&#44; reported a response rate to the drug of 80&#37;&#44; higher than that reported by our study and by the OBSERVE study&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">To conclude&#44; in clinical practice BLM has proven to be an alternative therapy to consider in patients with LES with cutaneous manifestations or joints refractory to standard immunosuppressants&#46;</p></span>"
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Letter to the Editor
Belimumab in systemic lupus erythematosus: Experience in clinical practice settings in a regional hospital
Belimumab en lupus eritematoso sistémico: experiencia en práctica clínica en un hospital comarcal
Leyre Riancho-Zarrabeitia
Corresponding author
leriancho@gmail.com

Corresponding author.
, Ignacio Villa Blanco, Montserrat Santos-Gómez, Elena Aurrecoechea
Servicio de Reumatología, Hospital Sierrallana, Torrelavega, Cantabria, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Belimumab &#40;BLM&#41;&#44; a soluble human monoclonal antibody which inhibits the stimulator factor of lymphocyte B &#40;BLyS&#41;&#44; is the only biologic drug approved for the treatment of system lupus erythematosus &#40;SLE&#41;&#46; It is recommended in patients with active SLE &#40;excluding patients with severe renal compromise or compromise of the central nervous system&#41;&#44; with positive antibodies and high grade disease activity despite standard treatment&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We now present the clinical experience of BLM use in a regional hospital servicing a population of 165&#44;000 inhabitants&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Eleven patients with SLE who had received BLM at some time were included&#46; One hundred per cent were female&#44; with a mean age at lupus diagnosis of 31&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;7 years&#46; Regarding clinical manifestations that presented during the course of the disease&#44; joints were most commonly affected &#40;100&#37;&#41;&#44; followed by cutaneous &#40;81&#37;&#41;&#44; haematological &#40;64&#37;&#41;&#44; renal &#40;27&#37;&#41;&#44; pulmonary &#40;9&#37;&#41; and cardiac &#40;9&#37;&#41; manifestations&#46; One hundred per cent of patients presented positivity for antinuclear antibodies&#44; with 27&#37; being positive for anti-DNA native antibodies&#44; 45&#37; for anti-SSA antibodies and 36&#37; for anti-SSB antibodies&#46; 45&#37; of patients presented with positivity for antiphospholipid antibodies and over one third presented with hypocomplementemia&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Regarding treatments prior to the initiation of BLM&#44; 100&#37; of patients had received antimalarial drugs&#44; over 80&#37; methotrexate and 27&#37; azathioprine&#46; Twenty seven per cent had received anti-TNF drugs&#44; 18&#37; cyclophosphamide and 18&#37; leflunomide&#46; One of the patients had received treatment with tacrolimus and rituximab&#46; The mean age of the patients at treatment initiation with BLM was 38&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;6 years&#46; The main manifestations for which treatment was prescribed were joint symptoms followed by cutaneous symptoms&#46; Over 60&#37; of patients underwent an improvement of cutaneous and joint symptoms&#44; with no resolution of lymphopenia being observed in our patients&#46; In 4 of them &#40;37&#37;&#41;&#44; treatment was suspended due to ineffectiveness after a median duration of 12&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;3 months&#46; Particular mention is of one patient who developed a type IV lupus nephritis during treatment&#46; Treatment was not definitively suspended due to side effects in any cases but was temporarily suspended in one patient &#40;9&#37;&#41; due to a respiratory infection&#46; With regard to concomitant treatments&#44; in 3 of them &#40;27&#37;&#41; treatment with BLM led to reduced doses of concomitant treatment &#40;methotrexate&#44; mycophenolate&#41; and it was not possible to assess the possible corticoid sparing effect given the retrospective nature of the study&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">There have been several reports of patient cohorts in U&#46;S&#46;A&#46;&#44; Canada and Germany<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#8211;3</span></a> treated with BLM with favourable results on the reduction of activity&#44; improvements in lab tests and steroid sparing&#46; However&#44; few data on clinical practice is available in Mexico&#46; The OBSERVE<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> study which included 64 patients with SLE&#44; showed an improvement of &#8805;20&#37;&#44; &#8805;50&#37;&#44; &#8805;80&#37; in 72&#37;&#44; 52&#37; and 27&#37; of cases&#44; respectively&#46; The BIOGEAS<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> study which included 10 patients with SLE refractory to antimalarial drugs and at least one other immunosuppressant&#44; where manifestations of BLM were mucocutaneous&#44; reported a response rate to the drug of 80&#37;&#44; higher than that reported by our study and by the OBSERVE study&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">To conclude&#44; in clinical practice BLM has proven to be an alternative therapy to consider in patients with LES with cutaneous manifestations or joints refractory to standard immunosuppressants&#46;</p></span>"
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Article information
ISSN: 21735743
Original language: English
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