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IDENTIFYING PATIENTS FOR BENLYSTA IN CLINICAL PRACTICE
SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) IS A CHRONIC, MULTISYSTEM AUTOIMMUNE DISEASE CHARACTERIZED BY
- Diverse clinical manifestations, which are the result of inflammation in multiple organ systems
- Waxing and waning disease activity, with signs of
active disease often appearing or disappearing despite standard therapy - Pathologic production of autoantibodies directed against self-antigens
- Antinuclear autoantibodies are
hallmark ofdisease - Abnormal activation of certain cells, including autoreactive B cells
- Antinuclear autoantibodies are
Several clinical tools have been developed to measure active SLE, including SELENA-SLEDAI, BILAG, and PGA.
- Diverse clinical manifestations, which are the result of inflammation in multiple organ systems
- Waxing and waning disease activity, with signs of
active disease often appearing or disappearing despite standard therapy - Pathologic production of autoantibodies directed against self-antigens
- Antinuclear autoantibodies are
hallmark ofdisease - Abnormal activation of certain cells, including autoreactive B cells
- Antinuclear autoantibodies are
Several clinical tools have been developed to measure active SLE, including SELENA-SLEDAI, BILAG, and PGA.
| SELENA-SLEDAI1,2 | BILAG3 | PGA |
|---|---|---|
|
|
|
Consider evaluating your patients for BENLYSTA if 4-8
- Patient is 18 years of age or older and has been diagnosed with SLE according to the American College of Rheumatology criteria
- Patient meets at least 1 of the following:
- Antinuclear antibody (ANA) titer ≥1:80
- Anti-dsDNA autoantibodies ≥30 IU/mL
- Patient is currently receiving any of the following types of standard therapy, alone or in combination, for ≥30 days:
- Antimalarial
- Immunosuppressive
- Corticosteroid
- NSAID
- Patient has active disease*
- SELENA-SLEDAI score ≥8 for BLISS-SC and NE Asia
- SELENA-SLEDAI score ≥6 for BLISS-52 and BLISS-76
*Can include both clinical† and serological‡ manifestations of SLE.
†eg, arthritis, rash, hair loss.
‡eg, decreased complement and anti-dsDNA.
- SELENA-SLEDAI score ≥8 for BLISS-SC and NE Asia
- Patient does not have severe active lupus nephritis
- Patient does not have severe active CNS lupus
- Patient is not using other biologics or IV cyclophosphamide
SELENA-SLEDAI = Safety of Estrogens in Lupus Erythematosus: National Assessment Version of the Systemic Lupus Erythematosus Disease Activity Index.
BILAG = British Isles Lupus Assessment Group.
PGA = Physician’s Global Assessment.
REFERENCES:
- Bombardier C, Gladman DD, Urowitz MB, Caron D, Chang CH. Derivation of the SLEDAI. A disease activity index for lupus patients. The Committee on Prognosis Studies in SLE. Arthritis Rheum. 1992;35(6):630-640.
- Petri M, Kim MY, Kalunian KC, et al. Combined oral contraceptives in women with systemic lupus erythematosus. N Engl J Med. 2005;353:2550-2558.
- Hay EM, Bacon PA, Gordon C, et al. The BILAG index: a reliable and valid instrument for measuring clinical disease activity in systemic lupus erythematosus. QJM. 1993;86(7):447-458.
- Data on file, Human Genome Sciences, Inc.
- Stohl W, Schwarting A, Okada M, et al. Efficacy and safety of subcutaneous belimumab in systemic lupus erythematosus: a fifty-two–week randomized, double-blind, placebo-controlled study. Arthritis Rheumatol. 2017;69(5):1016-1027.
- Navarra SV, Guzmán RM, Gallacher AE, et al. Efficacy and safety of belimumab in patients with active systemic lupus erythematosus: a randomised, placebo-controlled, phase 3 trial. Lancet. 2011;377(9767):721-731.
- Furie R, Petri M, Zamani O, et al. A phase III, randomized, placebo-controlled study of belimumab, a monoclonal antibody that inhibits B lymphocyte stimulator, in patients with systemic lupus erythematosus. Arthritis Rheum. 2011;63(12):3918-3930.
- Zhang F, Bae SC, Bass D, et al. A pivotal phase III, randomised, placebo-controlled study of belimumab in patients with systemic lupus erythematosus located in China, Japan and South Korea. Ann Rheum Dis 2018;77:355-363.
INDICATION
BENLYSTA is indicated for patients aged ≥5 years with active, autoantibody-positive systemic lupus erythematosus (SLE) who receive standard therapy. The subcutaneous (SC) formulation is approved for patients aged ≥18 years. BENLYSTA is not indicated or recommended in patients with severe active lupus nephritis, or severe active central nervous system lupus, or in combination with other biologics or intravenous cyclophosphamide.
IMPORTANT SAFETY INFORMATION
CONTRAINDICATION
Previous anaphylaxis with BENLYSTA.
WARNINGS AND PRECAUTIONS
Mortality
In adult intravenous (IV) clinical trials, death occurred in 0.8% of patients treated with BENLYSTA and in 0.4% of patients receiving placebo; etiologies included infection, cardiovascular disease, and suicide. In the adult SC clinical trial, death occurred in 0.5% of patients receiving BENLYSTA and in 0.7% of patients receiving placebo; infection was the most common cause of death.
Serious Infections
Serious and sometimes fatal infections have been reported in patients receiving immunosuppressive agents, including BENLYSTA. The most frequent serious infections in adults treated with BENLYSTA IV included pneumonia, urinary tract infection, cellulitis, and bronchitis. Use caution in patients with severe or chronic infections, and consider interrupting therapy in patients with a new infection.
Progressive Multifocal Leukoencephalopathy (PML): Cases of JC virus-associated PML resulting in neurological deficits, including fatal cases, have been reported in patients with SLE receiving immunosuppressants, including BENLYSTA. If PML is confirmed, consider stopping immunosuppressant therapy, including BENLYSTA.
Hypersensitivity Reactions (including Anaphylaxis)
Acute hypersensitivity reactions, including anaphylaxis (eg, hypotension, angioedema, urticaria or other rash, pruritus, and dyspnea) and death, have been reported, including in patients who have previously tolerated BENLYSTA. Generally, reactions occurred within hours of the infusion but may occur later. Non-acute hypersensitivity reactions (eg, rash, nausea, fatigue, myalgia, headache, and facial edema) typically occurred up to a week after infusion. Patients with a history of multiple drug allergies or significant hypersensitivity may be at increased risk. With BENLYSTA SC, systemic hypersensitivity reactions were similar to those in IV trials.
Healthcare providers (HCPs) should monitor patients during and after IV administration and be prepared to manage anaphylaxis; discontinue immediately in the event of a serious reaction. Premedication may mitigate or mask a hypersensitivity response. Advise patients about hypersensitivity symptoms and instruct them to seek immediate medical care if a reaction occurs.
Infusion Reactions
Serious infusion reactions (eg, bradycardia, myalgia, headache, rash, urticaria, and hypotension) were reported in adults. HCPs should monitor patients and manage reactions if they occur. Premedication may mitigate or mask a reaction. If an infusion reaction develops, slow or interrupt the infusion.
Depression and Suicidality
In clinical trials, psychiatric disorders (depression, suicidal ideation and behavior) were reported more frequently in patients receiving BENLYSTA than placebo. In adult trials, psychiatric events reported more frequently with BENLYSTA IV related primarily to depression-related events, insomnia, and anxiety; serious psychiatric events included serious depression and suicidality, including 2 completed suicides. No serious depression-related events or suicides were reported in the BENLYSTA SC trial. Before adding BENLYSTA, physicians should assess patients’ risk of depression and suicide and monitor them during treatment. Instruct patients to contact their HCP if they experience new/worsening depression, suicidal thoughts, or other mood changes.
Malignancy
The impact of BENLYSTA on the development of malignancies is unknown; its mechanism of action could increase the risk for malignancies.
Immunization
Live vaccines should not be given for 30 days before or concurrently with BENLYSTA as clinical safety has not been established.
Use With Biologic Therapies or IV Cyclophosphamide
BENLYSTA has not been studied and is not recommended in combination with other biologic therapies, including B-cell targeted therapies, or IV cyclophosphamide.
ADVERSE REACTIONS
The most common serious adverse reactions in adults were serious infections: BENLYSTA IV 6.0% (placebo 5.2%), some of which were fatal. Adverse reactions occurring in ≥3% of adults and ≥1% more than placebo: nausea 15% (12%); diarrhea 12% (9%); pyrexia 10% (8%); nasopharyngitis 9% (7%); bronchitis 9% (5%); insomnia 7% (5%); pain in extremity 6% (4%); depression 5% (4%); migraine 5% (4%); pharyngitis 5% (3%); cystitis 4% (3%); leukopenia 4% (2%); viral gastroenteritis 3% (1%).
Adverse reactions in pediatric patients aged ≥5 years receiving BENLYSTA IV were consistent with those observed in adults.
The safety profile observed for BENLYSTA SC in adults was consistent with the known safety profile of BENLYSTA IV with the exception of local injection site reactions.
USE IN SPECIFIC POPULATIONS
Pregnancy: There are insufficient data in pregnant women to establish whether there is drug-associated risk for major birth defects or miscarriage. After a risk/benefit assessment, if prevention is warranted, women of childbearing potential should use contraception during treatment and for ≥4 months after the final treatment.
Pregnancy Registry: HCPs are encouraged to register patients and pregnant women are encouraged to enroll themselves by calling 1-877-681-6296.
Lactation: No information is available on the presence of belimumab in human milk, the effects on the breastfed infant, or the effects on milk production. Consider developmental and health benefits of breastfeeding with the mother’s clinical need for BENLYSTA and any potential adverse effects on the breastfed child or from the underlying maternal condition.
Pediatric Use: The safety and effectiveness have not been established for BENLYSTA IV in patients <5 years of age and for BENLYSTA SC in patients <18 years of age.
Black/African American Patients: In clinical trials there have been mixed results regarding how well BENLYSTA works in this patient population. Consider risks and benefits when prescribing BENLYSTA.
Please see full Prescribing Information and Medication Guide for BENLYSTA.
