Factors influencing the choice of non-biologic versus biologic immunosuppressive therapy in systemic lupus erythematosus
In systemic lupus erythematosus (SLE), treatment decisions are guided by clinical judgment based on disease manifestations and safety profiles rather than standardized protocols, particularly for extra-renal involvement. In this study of 356 SLE patients, 190 receiving non-biologic immunosuppressants and 166 receiving biologics, we investigated the association of clinical phenotypes with treatment initiation and the impact of damage (SLICC-DI), comorbidities, and hospitalization history on these choices. Dominant clinical phenotypes were defined qualitatively using BILAG and SLEDAI domains. Logistic regression models with Simes-Hochberg correction revealed that renal phenotypes were strongly associated with mycophenolate initiation (OR = 4.09, p < 0.001), musculoskeletal phenotypes with methotrexate (OR = 4.86, p < 0.001). Belimumab was preferentially initiated in patients with musculoskeletal involvement and high SLEDAI scores (OR = 1.84, p = 0.03; OR = 2.03, p = 0.03, respectively). Notably, the association between mycophenolate and the renal phenotype persisted in the presence of comorbidities but was not observed in patients with SLICC-DI > 0 or more than one hospitalization in the previous year. Similarly, methotrexate and belimumab associations were diminished in patients with a Charlson comorbidity index > 1 or damage (SLICC-DI > 0). This study offers novel insights into the clinical determinants of immunosuppressive therapy selection in SLE and underscore the potential for tailoring treatment strategies to individual patient profiles.
Authors
- Elena Bartoloni (ORCID: https://orcid.org/0000-0003-4776-2136)
- Alessandra Bortoluzzi (ORCID: https://orcid.org/0000-0003-2416-8134)
- Fabrizio Conti
- Valentina Canti (ORCID: https://orcid.org/0000-0001-9757-6089)
- Davide Rozza (ORCID: https://orcid.org/0000-0003-2648-742X)
- Lorenzo Cavagna (ORCID: https://orcid.org/0000-0003-3292-1528)
- Valeria Orefice (ORCID: https://orcid.org/0000-0002-6478-4831)
- Gian Domenico Sebastiani (ORCID: https://orcid.org/0000-0003-2969-6649)
- Caterina Naclerio
- Franco Franceschini (ORCID: https://orcid.org/0000-0003-3678-6124)
- Giorgio Pettiti (ORCID: https://orcid.org/0000-0002-0017-6060)
- L. Coladonato (ORCID: https://orcid.org/0000-0001-8833-7289)
- Simone Parisi (ORCID: https://orcid.org/0000-0003-4496-8315)
- Carlo Garaffoni
- Francesca Bobbio‐Pallavicini (ORCID: https://orcid.org/0000-0003-0047-7610)
- Francesca Crisafulli (ORCID: https://orcid.org/0000-0003-0319-1538)
- Marcello Govoni (ORCID: https://orcid.org/0000-0003-0499-5773)
- Jelena Blagojević (ORCID: https://orcid.org/0000-0001-7102-5510)
- Serena Guiducci (ORCID: https://orcid.org/0000-0003-2722-6475)
- Silvia Mancuso (ORCID: https://orcid.org/0000-0002-5820-3316)
- Angelo A. Manfredi (ORCID: https://orcid.org/0000-0001-8370-6970)
- I. Prevete (ORCID: https://orcid.org/0000-0001-5666-1615)
- Andrea Doria (ORCID: https://orcid.org/0000-0003-0548-4983)
- Ilaria Cavazzana (ORCID: https://orcid.org/0000-0002-2757-7120)
- Chiara Scirocco (ORCID: https://orcid.org/0000-0002-0095-300X)
- Giulia Pazzola
- Marta Mosca
- Margherita Zen
- Paola Conigliaro (ORCID: https://orcid.org/0000-0001-7905-8413)
- Giacomo Emmi (ORCID: https://orcid.org/0000-0001-9575-8321)
- Greta Carrara (ORCID: https://orcid.org/0000-0001-9752-2275)
- Antônio Carlos Marangoni (ORCID: https://orcid.org/0000-0001-9463-9830)
- Maria Gerosa (ORCID: https://orcid.org/0000-0001-5241-5847)
- Enrica Bozzolo (ORCID: https://orcid.org/0000-0002-1923-5075)
- Giuseppe A. Ramirez (ORCID: https://orcid.org/0000-0002-2889-366X)
- Maria Chiara Ditto (ORCID: https://orcid.org/0000-0001-5025-287X)
- Francesca Romana Spinelli (ORCID: https://orcid.org/0000-0003-1969-2097)
- Micol Frassi
- Ettore Silvagni (ORCID: https://orcid.org/0000-0001-7654-8222)
- Sara Ferrigno (ORCID: https://orcid.org/0000-0003-4076-3734)
- Carlo Alberto Scirè
- Luca Iaccarino
Institutions
- University of Pisa (IT)
- University of Rome Tor Vergata (IT)
- University of Padua (IT)
- University of Trieste (IT)
- Vita-Salute San Raffaele University (IT)
- University of Ferrara (IT)
- University of Perugia (IT)
- Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT)
- Azienda Sanitaria Unità Locale di Reggio Emilia (IT)
- Ospedale di Cattinara (IT)
- Azienda Unità Sanitaria Locale di Ferrara (IT)
- Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT)
- Istituto Ortopedico Gaetano Pini (IT)
- Arcispedale Sant'Anna (IT)
- Azienda Sanitaria Ospedaliera S.Croce e Carle Cuneo (IT)
- Società Italiana di Reumatologia (IT)
- Policlinico San Matteo Fondazione (IT)
- Carlo Forlanini Hospital (IT)
- Istituti di Ricovero e Cura a Carattere Scientifico (IT)
- University of Florence (IT)
- University of Bari Aldo Moro (IT)
- Saipem (Italy) (IT)
- University of Milano-Bicocca (IT)
- University of Brescia (IT)
- Sapienza University of Rome (IT)
- Union des Industries Ferroviaires Européennes (BE)
Publication Details
- Journal
- Scientific Reports
- Published
- 2025-10-13
- DOI
- https://doi.org/10.1038/s41598-025-19654-8
- Citations
- 2
- Primary Topic
- Systemic Lupus Erythematosus Research
- Type
- article
- Field-Weighted Citation Impact
- 3.34