Efficacy And Safety Of Belimumab At Different Doses In Combination With Standard Therapy In The Treatment Of Systemic Lupus Erythematosus:A Network Meta-analysis

Objective:To compare the efficacy and safety of different doses of belimumab in the treatment of active SLE by using a mesh meta-analysis.Methods:Three medical literature databases(Pub Med,Embase,and Cochrane Library as of December 2020)were searched to compare the efficacy and safety of four treatments(belimumab 1mg/kg IV+SOC,belimumab 10mg/kg IV+SOC,belimumab 200mg/ week SC+SOC,and placebo +SOC)in the treatment of active SLE.Stata(15.0)software was used for network analysis of the data included in the study.Results:Results of a network meta-analysis of 3521 patients included in 5 studies showed that the overall OR and 95%CI of SRI-4 response rates compared with placebo + So C were: Belimumab 200 mg SC+ So C 1.69(1.27-2.26),Belimumab 1mg/kg IV+ So C1.38(1.10-1.73),and Belimumab 10mg/kg,IV+SOC was 1.67(1.38-2.03),and the confidence interval of the combined effect size >1.Indicating that the difference is statistically significant.Compared with placebo + Soc,the percentage of patients whose glucocorticoid dose was reduced by belimumab 1mg/kg IV+ Soc had a total OR and95%CI of 1.59(1.07-2.35)1.66(1.12-2.46),respectively,with both confidence intervals for combined effect sizes >1,indicating that the difference was statistically significant;The percentage of patients whose glucocorticoid dose was reduced by belimumab1mg/kg IV+ Soc compared with placebo + Soc had a total OR and 95%CI of1.59(1.07-2.35)1.66(1.12-2.46),respectively,with both confidence intervals for combined effect sizes >1,indicating that the difference was statistically significant;Belimumab 200 mg SC+ So C was 1.65(0.96-2.84)and the confidence interval contained 1,indicating that the difference was not statistically significant.There was no significant difference between the SAE and AE group about the confidence intervals of the combined effect sizes and incidence.In the SUCRA curve,belimumab 10 mg/kg IV+SOC had the highest SRI4 response rate,with an area under the curve of 80.8%.The other area under the showed that belimumab 200 mg SC +SOC was 79.4%,belimumab 1mg/kg IV+SOC was 39.7%,and placebo +SOC was 0.00%.Belimumab 10 mg/kg IV+So C had the highest response rate in the Sucra curve of the percentage of patients with reduced glucocorticoid dose,with an area under the curve of 69.8%.Belimumab 200 mg SC + So C had the lowest area of 12.0% on the Suc RA chart of SAE incidence,indicating that it was the safest intervention.Belimumab 200 mg SC + So C had the lowest area of18.5% in the Sucra curve of AE incidence,suggesting that it was the safest intervention.Conclusion:1.On the basis of SOC,Belimumab at 1mg/kg IV,10 mg/kg IV and 200 mg SC was superior to placebo in SRI response rates;Percentage of patients with Belimumab reduced glucocorticoid doses at 1mg/kg IV and 10 mg/kg IV were better than those treated with placebo.Belimumab 10 mg/kg IV was the best guideline.2.In the incidence of AE and SAE,there was no statistically significant difference among the groups,and belimumab 200 mg SC + So C had the best relative safety.3.Subcutaneous administration of belimumab is expected to be a new which is more convenient for people to use.