The aim of the European Journal of Rheumatology is to cover various aspects of rheumatology for its readers, encompassing the spectrum of diseases with arthritis, musculoskeletal conditions, autoinflammatory diseases, connective tissue disorders, osteoporosis, translational research, the latest therapies and treatment programs. European Journal of Rheumatology publishes original articles, invited reviews, case based reviews, letters to the editor and images in rheumatology. The publication language of the journal is English.

Background Belimumab was the first biological drug approved for Systemic Lupus Erythematosus (SLE). There is not a review focusing on all real-life experience with belimumab to date that could help to describe how this drug behaves in the Spanish clinical setting. Objective To describe the characteristics of SLE patients treated with belimumab added to standard of care in real-clinical setting in Spain. Methods We conducted a comprehensive scoping review of real-world data (RWD) according to PRISMA Scoping Reviews Checklist and the framework proposed by Arksey and O’Malley. PubMed and EMBASE were searched without language restriction and hand searches of relevant articles were examined. Results We included data from 222 patients treated with belimumab for SLE included in 19 RWD studies conducted in Spain. The mean age was 40.9 years, 84.2% were female, and baseline scores SELENA-SLEDAI ranged between 5.9 and 12. Lupus nephritis basal prevalence was of 2.7%. The main reason for belimumab initiation was previous treatments lack of efficacy (69.7%) and the most common laboratory abnormalities were hypocomplementemia (40.9%), ANA + (34.2%), and anti-DNA (33.3%). The addition of belimumab to standard therapy was associated with a reduction of daily glucocorticoids intake in 1.4–11.1 mg at 6 months. Belimumab discontinuation was observed in 18.6% of patients. Conclusion Our study helps to further explore the profile of SLE patients most likely to be treated with belimumab. Key Points• Scientific evidence in SLE provided by randomized controlled trials sometimes differs from the actual treatment of SLE patients in routine clinical practice.• There is a lack of published “real-world” data on SLE treatment with belimumab in Spain.• This scoping review intends to describe and analyze the clinical characteristics of SLE patients receiving belimumab in a real-life setting in Spain.• These “real-world” clinical experience can provide a more realistic view of the overall patterns of SLE care compared with clinical trials.

BackgroundThe application of the “treat-to-target” strategy in rheumatoid arthritis requires being proactive in the management of the disease to get the better outcomes. The treatment changes in daily practice are directed to improve the efficacy and/or tolerance, and also reduce the toxicity.ObjectivesThe present study aimed to describe the percentage of patients who suffered a change in their synthetic DMARD regimen due to loss of efficacy (LoE), adverse events (AEs), intolerance, and other reasons. Also the therapeutic strategies chosen by rheumatologists for management of synthetic DMARD after treatment failure were evaluated.MethodsThis retrospective, observational and multicenter study included patients diagnosed with RA (fulfillment of the ACR/EULAR 2010 diagnostic criteria) from 2008 to 2012, who have started on at least one synthetic DMARD within this period. Patients were included in a routine clinical visit performed in 2014. Patient clinical characteristics and previous/current medications for RA were retrospectively collected from patients' medical records after the consensus of the participant rheumatologists in the study. Descriptive analysis of the data retrieved at the study visit in 2014 is presented.Results12 sites in Andalucía (Spain) included 301 patients (mean age: 56.6±14.0; female: 71%; RA duration: 3.6±1.5), whose clinical characteristics are shown in the table. 57% of patients have received a single synthetic DMARD, with metothrexate (MTX) (57%), leflunomide (20%) and hydroxychloroquine (9%) as the most commonly DMARDs prescribed as monotherapy. During the study period, 69% of patients suffered ≥1 change in the first- or subsequent-line DMARDs for AEs, intolerance or LoE. Of the 341 changes registered, 42% were due to LoE, 28% due to AEs (31% liver disorders, 19% gastrointestinal symptoms), 14% due to intolerance, and the remaining 16% due to the following reasons: patient preference, lack of adherence, pregnancy plans and loss of follow-up. DMARD was definitely and temporarily interrupted in 35% and 8% of the cases, respectively. Both the addition of and the switch to another conventional DMARD occurred in 11%, and DMARD dosage was adjusted in 28% of the cases.Table 1.Patients' disease characteristicsCharacteristicsAt FAME initiationAt the study visitSwollen joint count, mean ± SD4.4±4.51.2±2.4Tender joint count, mean ± SD5.9±5.22.2±3.4ESR (mm/h), mean ± SD29.0±21.717.2±15.6CRP (mg/l), mean ± SD17.6±27.47.6±14.5DAS28, mean ± SD4.6±1.53.2±1.4CDAI, mean ± SD19.5±12.310.5±10.0ConclusionsIn clinical practice, MTX was the main DMARD prescribed for initial treatment. Most of all changes made in DMARD therapy (84%) were due to lack of efficacy, AEs and intolerance. Definitely interruptions (35%) and dosage adjustments (28%) were the therapeutic strategies mainly chosen by rheumatologists.Disclosure of InterestNone declared