Definition and treatment of lupus flares measured by the BILAG index

Gordon, Caroline; Sutcliffe, Nurhan; SKan, J; Stoll, Thomas; Isenberg, David

doi:10.1093/rheumatology/keg382

Cited by 127 publications

(93 citation statements)

References 11 publications

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“…The BILAG index is a useful and reliable instrument to measure disease activity for each organ-based system (17). Moreover, the BILAG index correlates highly with other methods of measuring activity such as SLEDAI, and BILAG can easily detect flares (4,18).…”

Section: Discussionmentioning

confidence: 99%

Analysis of Complete Remission in Systemic Lupus Erythematosus Patients Over a 32‐Year Period

Medina-Quiñones

Ramos-Merino

Ruiz-Sada

et al. 2016

Arthritis Care & Research

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Objective. Systemic lupus erythematosus (SLE) is characterized by an unpredictable and fluctuating course. Although various methods have been developed to measure disease activity, there is still a lack of consensus about the optimal criteria for SLE remission. The principal aim of our study was to identify the number of lupus patients achieving a complete remission (implying that for 3 years there were no clinical or serologic features and no treatment with steroids and immunosuppressive drugs) in a single cohort of patients followed for a period of up to 32 years. In addition, we have identified patients in clinical but not serologic remission (known as serologically active, clinically quiescent disease [SACQ]) and vice versa. We were particularly interested to determine the factors associated with complete remission. Methods. Eligible patients were followed up in the University College Hospital Lupus cohort from January 1978 until December 2010 for a period of at least 3 years. Complete remission was defined as a period of at least 3 years with clinical inactivity (British Isles Lupus Assessment Group scores of C, D, or E only) and laboratory remission (no antibodies to double-stranded DNA and normal complement C3 levels), and being off-treatment with corticosteroids and immunosuppressants. Antimalarial and nonsteroidal antiinflammatory drugs were allowed. Results. Of 624 lupus patients at our hospital, a total of 532 patients met the strict inclusion criteria for the study. Of these 532 patients, 77 patients (14.5%) achieved complete remission for at least 3 years, and 23 (4.3%) achieved complete remission for a minimum period of 10 years. Ten of these 77 patients were subsequently lost to followup, and, interestingly, flares occurred subsequently in 15 of the 67 remaining patients (22.4%). Three patients relapsed after the tenth year of remission. Forty-five patients (8.5%) fulfilled the requirement for SACQ, and 66 patients (12.4%) achieved only serologic remission. Conclusion. Our study indicated that 14.5% of lupus patients achieved a complete remission for 3 years. However, flares may continue to occur beyond 10 years of remission. Long-term followup of SLE is therefore mandatory.

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Section: Discussionmentioning

confidence: 99%

Analysis of Complete Remission in Systemic Lupus Erythematosus Patients Over a 32‐Year Period

Medina-Quiñones

Ramos-Merino

Ruiz-Sada

et al. 2016

Arthritis Care & Research

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“…Disease response during the continuation study is assessed every 8 weeks by PGA 30 and every 16 weeks by SELENA-SLEDAI 31 , British Isles Lupus Assessment Group (BILAG) 32,33,34 , and SLE Flare Index (SFI) 30,31,35 . Blood samples for evaluation of autoantibody and complement are collected every 16 weeks.…”

Section: Methodsmentioning

confidence: 99%

Disease Control and Safety of Belimumab Plus Standard Therapy Over 7 Years in Patients with Systemic Lupus Erythematosus

Ginzler

Wallace²,

Merrill³

et al. 2013

J Rheumatol

164

116

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Objective.To evaluate the efficacy/safety of belimumab plus standard therapy in patients (n = 449) with active systemic lupus erythematosus (SLE) treated up to 7 years (n = 177 currently ongoing).Methods.Patients (n = 345) who completed a double-blind, placebo-controlled, 52-week study of belimumab 1, 4, or 10 mg/kg and 24-week extension of belimumab (placebo switched to 10 mg/kg; belimumab same dose or switched to 10 mg/kg) could receive belimumab 10 mg/kg in an open-label continuation study (n = 296). Disease activity was analyzed in patients with active SLE at baseline of the initial study. Biomarker and SLE medication changes were evaluated, and adverse events (AE) were monitored throughout the study.Results.Total belimumab exposure over 7 years (double-blind and open-label periods): 1746 patient-years. SLE Responder Index (SRI) response rates at Week 52 in autoantibody-positive patients: placebo, 29%; belimumab, 46% (p < 0.05). In the continuation study, 57% of auto-antibody-positive patients had an SRI response by Year 2 and 65% by Year 7; severe flares occurred in 19% with placebo and 17% with belimumab during the first year, with the annual rate declining to 2%–9% during years 2–7. Anti-dsDNA autoantibodies in patients positive for them at baseline had a progressive decline of 40%–60% from baseline over 2–7 years with belimumab. Corticosteroid use decreased over time with ≥ 50–55% reduction in median dose during years 5–7. Serious and overall annual AE rates, including infections, were generally stable or decreased during 7-year treatment.Conclusion.Disease control and safety profile were maintained in patients with active SLE taking belimumab plus standard therapy for up to 7 years. [ClinicalTrials.gov numbers: NCT00071487 and NCT00583362]

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“…Disease activity was defined according to the British Isles Lupus Activity Group (BILAG) index (17,18), which consists of 86 questions related to symptoms, examination findings, and laboratory results across 8 organ systems. A score of BILAG A in an organ system represents severe disease activity, reflecting the need for disease-modifying therapy (i.e., high-dose corticosteroids/ immunosuppressants), and a score of BILAG B in an organ system represents moderate disease activity, reflecting the need for symptomatic therapy (i.e., hydroxychloroquine/ nonsteroidal antiinflammatory drugs [NSAIDs]/low-tomoderate-dose corticosteroids).…”

Section: Methodsmentioning

confidence: 99%

The efficacy and safety of abatacept in patients with non–life‐threatening manifestations of systemic lupus erythematosus: Results of a twelve‐month, multicenter, exploratory, phase IIb, randomized, double‐blind, placebo‐controlled trial

Merrill¹,

Burgos‐Vargas²,

Westhovens³

et al. 2010

Arthritis & Rheumatism

346

180

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Objective. To evaluate abatacept therapy in patients with non-life-threatening systemic lupus erythematosus (SLE) and polyarthritis, discoid lesions, or pleuritis and/or pericarditis.Methods. In a 12-month, multicenter, exploratory, phase IIb randomized, double-blind, placebocontrolled trial, SLE patients with polyarthritis, discoid lesions, or pleuritis and/or pericarditis were randomized at a ratio of 2:1 to receive abatacept (ϳ10 mg/kg of body weight) or placebo. Prednisone (30 mg/day or equivalent) was given for 1 month, and then the dosage was tapered. The primary end point was the proportion of patients with new flare (adjudicated) according to a score of A/B on the British Isles Lupus Assessment Group (BILAG) index after the start of the steroid taper. Results

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Definition and treatment of lupus flares measured by the BILAG index

Abstract: These results are consistent with the principles upon which the BILAG index was devised and suggest that a moderate disease flare can be defined as a new B score following a C, D or E score according to the BILAG index.

Cited by 127 publications

References 11 publications

Analysis of Complete Remission in Systemic Lupus Erythematosus Patients Over a 32‐Year Period

Analysis of Complete Remission in Systemic Lupus Erythematosus Patients Over a 32‐Year Period

Disease Control and Safety of Belimumab Plus Standard Therapy Over 7 Years in Patients with Systemic Lupus Erythematosus

The efficacy and safety of abatacept in patients with non–life‐threatening manifestations of systemic lupus erythematosus: Results of a twelve‐month, multicenter, exploratory, phase IIb, randomized, double‐blind, placebo‐controlled trial

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