1b) Our topic for🆓CE/#CME : #belimumab and prevention of de novo #renal_flare.#MedTwitter #nephtwitter @ISNkidneycare #lupus @MedTweetorials pic.twitter.com/M4HhPsZ6O9
— @CKD_ce (@ckd_ce) October 31, 2023
2b) This program is intended for #healthcare professionals. Follow this 🧵to earn 🆓 CE/#CME courtesy of the collaboration of @ckd_ce and @KIReports. Faculty disclosures at https://t.co/PHlIppl6Yw. There was no financial support provided by industry for this program.
— @CKD_ce (@ckd_ce) October 31, 2023
3) Let's start with #MedHist!
— @CKD_ce (@ckd_ce) October 31, 2023
🗝️It's always fascinating!
🗝️In 1800s, Ferdinand von Hebra used the metaphor of a 🦋 to describe the classic #malar rash observed in systemic #lupus erythematosus (#SLE) pic.twitter.com/GIU5ueGy1d
5) 💊 In the 1980s, it was demonstrated that #cytotoxic drugs➕#corticosteroids stop the progression of #renalfailure
— @CKD_ce (@ckd_ce) October 31, 2023
💊 Inclusion of #cyclophosphamide increased patient survival to 80% after five years
👉seminal article in @nejm at:https://t.co/wObxoyVZki
7) 💊 Belimumab: a monoclonal antibody (#mAb) against B cell activating factor (#BAFF)
— @CKD_ce (@ckd_ce) October 31, 2023
✅ First biological treatment for #SLE to be authorized, in 2011
✅Subsequently approved for the tx of #LN, Dec 2020, based on #BLISS_LN, by Furie et al in @nejm: 🔓https://t.co/gqk15BYVQk pic.twitter.com/BoKRsWrFCa
9) Check out the beautiful #visualabstract by @DrPSVali on that article here: pic.twitter.com/6F4V28KaRl
— @CKD_ce (@ckd_ce) October 31, 2023
11) 💉Intervention: #Belimumab vs placebo, in addition to standard therapy (ST) for a duration as represented here: pic.twitter.com/eZeTcSVknw
— @CKD_ce (@ckd_ce) October 31, 2023
13) 📊Results:
— @CKD_ce (@ckd_ce) October 31, 2023
Of 1844 study participants with all trials combined
📌 602 received IV #belimumab 10 mg/kg
📌311 received IV belimumab 1 mg/kg
📌343 received SC belimumab
📌588 study participants received placebo
15a) ⚡Individuals who received IV #belimumab 1 mg/kg (non-licensed dose) ➡️ lower proportion of de novo renal flares (4.2%) vs placebo-treated pts (8.7%; P = 0.036).
— @CKD_ce (@ckd_ce) October 31, 2023
16) 🔥Important predictors of renal flares: positive anti-#dsDNA and #anticardiolipin (IgA and IgG) antibodies pic.twitter.com/icvrYbNxdw
— @CKD_ce (@ckd_ce) October 31, 2023
18) 🔍@IoannisParodis et al hypothesized: de novo #LN cases tx'd w/#belimumab may occur
— @CKD_ce (@ckd_ce) October 31, 2023
⁉️ Based on assumption that LN activation might result from drug's inhibition of regulatory B cell subsets
⁉️ Serum IL-10 drops quickly, noticeably, & persistently upon beginning belimumab Rx
20) Conclusion:
— @CKD_ce (@ckd_ce) October 31, 2023
🌟Asian descent: vulnerable to new onset renal involvement
📌In individuals with #SLE with no past history of LN;
🌟 low-dose IV 1 mg/kg & SC 200 mg #belimumab ➕nonbiological ST➡️protective against renal🔥
🌟permitted IV dose (10 mg/kg)➡️no obvious protection.
22a) So let's review. According to British Isles Lupus Assessment Group (#BILAG), score E means:
— @CKD_ce (@ckd_ce) October 31, 2023
a) active dz req'ing tx intensification
b) stable & mild dz
c) no current but history of involvement in that organ system
d) no history of or current involvement in that organ system
23a) Which of the following #interleukins has been hypothesized to contribute to development of de novo #renal flares in patients treated with #belimumab?
— @CKD_ce (@ckd_ce) October 31, 2023
24) And you just earned 0.5hr 🆓 CE/#CME! Claim your certificate at https://t.co/4vmLsTZ27l. Thanks for following this 🧵! Get more #MedEd #nephtwitter by FOLLOWING US here!
— @CKD_ce (@ckd_ce) October 31, 2023
Thanks to guest faculty @happiedoc & series editor @sophia_kidney!#FOAMed #nephtwitter #lupustwitter