COMPARATIVE ANALYSIS OF BELIMUMAB, ANIFROLUMAB, AND RITUXIMAB IN SYSTEMIC LUPUS ERYTHEMATOSUS: A RETROSPECTIVE STUDY OF CLINICAL AND ANALYTICAL OUTCOMES

PV258 / #502 Poster Topic: AS24 - SLE-Treatment Background/Purpose Systemic lupus erythematosus (SLE) is a complex autoimmune disorder with multisystem involvement, often presenting with high disease activity and diverse clinical manifestations. The advent of biological therapies has marked a significant advance in disease control for SLE patients. The latest ACR/EULAR 2023 guidelines recommend Belimumab and Anifrolumab as first-line options for moderate to high disease activity, with Rituximab reserved for refractory cases. Despite these guidelines, clinical responses vary considerably, necessitating close monitoring of laboratory parameters to assess and optimize disease management. Objectives : This study aimed to evaluate the clinical and analytical outcomes in SLE patients treated with Belimumab, Anifrolumab, and Rituximab over a 1-year period. Specifically, we sought to determine which treatment best controls disease activity through analysis of hemoglobin (Hb), leukocyte, lymphocyte, and platelet counts, complement levels (C3 and C4), and double-stranded DNA (dsDNA) antibody levels. Methods We conducted a retrospective study at a tertiary hospital, examining the use of Belimumab, Anifrolumab, and Rituximab in patients diagnosed with systemic lupus erythematosus (SLE) between 2010 and 2024. Diagnosis of SLE was established using the 2019 ACR/EULAR criteria. Data were collected on demographic variables, clinical manifestations of SLE, and laboratory parameters (hemoglobin, leukocytes, lymphocytes, platelets, C3, C4, and dsDNA) over 1 year of treatment for each biological therapy. Results A total of 45 patients were included in the study, with 25 receiving Belimumab, 14 receiving Anifrolumab, and 6 receiving Rituximab. The median age at diagnosis of 34.33 years (IQR: 16–60) and 93.33% being female. Of these, 95.56% received concomitant hydroxychloroquine therapy (mean dose: 355.81 mg/day). Clinical manifestations observed included articular involvement (95.56%), cutaneous involvement (71.11%), hematologic symptoms (84.44%), neurological symptoms (46.67%), and renal involvement (33.33%). The median treatment duration varied by therapy, with 18 months for Belimumab, 6 months for Anifrolumab, and 14 months for Rituximab. Discontinuation rates were higher in patients treated with Belimumab (10 patients) and Anifrolumab (5 patients) compared to Rituximab (3 patients), with causes including infections, lack of efficacy, and adverse events. Concomitant corticosteroids were used by 88% of Belimumab patients (median prednisone dose: 7.5 mg/day), 78% of Anifrolumab patients (5 mg/day), and 83.33% of Rituximab patients (10 mg/day). Anifrolumab provided the most consistent control over Hb levels, rare leukocyte drops below 4,000/µL, and stable lymphocyte and platelet counts, staying above 1,500/µL and 150,000/µL, respectively, with complement levels (C3 and C4) remaining mostly stable; however, dsDNA levels significantly increased by the end of the treatment period, suggesting ongoing disease activity. Belimumab showed moderate efficacy with generally stable Hb and leukocyte counts above threshold, along with lymphocyte and platelet counts; nevertheless, periodic drops in complement levels indicated some consumption, and dsDNA fluctuations pointed to intermittent disease activity. Rituximab, showed less consistent control, with Hb levels varying and occasional anemia, frequent drops in leukocyte and lymphocyte counts below thresholds and fluctuating platelet and complement levels, with notable complement consumption and persistently elevated dsDNA levels reflecting ongoing disease activity (Figure 1). Figure 1. Progression of dsDNA levels over 12 months Conclusions Anifrolumab demonstrated strong control over hematologic parameters and complement levels but did not achieve lower dsDNA levels, leaving the clinical significance of this finding unclear. In contrast, Belimumab and Rituximab, despite greater variability in hematologic control, maintained better stability in dsDNA and complement levels.

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