Belimumab or anifrolumab for systemic lupus erythematosus? A risk-benefit assessment.

Treatment of systemic lupus erythematosus (SLE) currently employs agents with relatively unselective immunosuppressive properties. However, two target-specific biological drugs have been approved: belimumab (anti-B-cell-activating factor/BAFF) and anifrolumab (anti-interferon alpha receptor-1/IFNAR1). Here, we performed a comparative risk-benefit assessment for both drugs based on the role of BAFF and IFNAR1 in host defense and the pathogenesis of SLE and by considering the available data on safety and efficacy. Due to differences in target expression sites, anti-IFNAR1, but not anti-BAFF, might elicit organ-specific effects, consistent with clinical efficacy data. The IFNAR1 is specifically involved in innate and adaptive antiviral immunity in most cells of the body. Consistent with this observation, the available safety data obtained from patients negatively selected for LN and neuropsychiatric SLE, primary immunodeficiencies, splenectomy and chronic HIV, HBV, HCV infections suggest an increased risk for some viral infections such as varicella zoster and perhaps influenza. In contrast, BAFF is mainly involved in adaptive immune responses in lymphoid tissues, thus anti-BAFF therapy modulates SLE activity and prevents SLE flares without interfering with local innate host defense mechanisms and should only marginally affect immune memory to previous pathogen exposures consistent with the available safety data from SLE patients without chronic HIV, HBV or HCV infections. When using belimumab and anifrolumab, careful patient stratification and specific precautions may minimize risks and maximize beneficial treatment effects for patients with SLE.

Telemedicine in rheumatology: a survey of patient and provider satisfaction with virtual care

1105 Table 1Telemedicine Seven-item QuestionnaireQuestionnaire Item Response N (%) How satisfied were you with your previous telemedicine visit? Highly satisfied 50 (50%) Satisfied 34 (34%) Neither satisfied nor unsatisfied 11 (11%) Not satisfied 5 (5%) Highly unsatisfied 0 (0%) Reasons for satisfaction? Avoid coming into the office 73 (73%) Call went smoothly 77 (77%) Decrease their concerns over condition, medications and risk of COVID-19 75 (75%) Reasons for unsatisfaction? Technical difficulties 4 (4%) Visit was too short 2 (2%) Visit was too basic for their needs 4 (4%) How comfortable were you with your previous telemedicine visits? Very comfortable 62 (62%) Comfortable 24 (24%) Neither comfortable nor uncomfortable 11 (11%) Uncomfortable 3 (3%) Highly uncomfortable 0 (0%) The physician was able to address what was bothering me through the telemedicine visit? Strongly agree 54 (54%) Agree 37 (37%) Don’t know 5 (5%) Disagree 4 (4%) Strongly disagree 0 (0%) Overall, compared to an in-person visit, the telemedicine visit was? Much better 10 (10%) Better 6 (6%) Same 57 (57%) Worse 25 (25%) Much worse 2 (2%) I would have a telemedicine appointment in the future, if given the option. Yes 77 (77%) Unsure 14 (14%) No 9 (9%) Abstract 1105 Table 2Demographic characteristics of study subjectsCharacteristics Categories N (%) Gender Male 9 (9%) Female 91 (91%) Age (years) 20-30 18 (18%) 30-40 22 (22%) 40-50 22 (22%) 50-60 21 (21%) 60-70 13 (13%) 70-80 4 (4%) Race White 41 (41%) Black or African American 25 (25%) Asian 7 (7%) Hispanic 26 (26%) Health insurance Insured 100 (100%) Uninsured 0 (0%) Diagnoses Systemic Lupus Erythematosus (SLE) 60 (60%) Rheumatoid Arthritis (RA) 7 (7%) Undifferentiated Connective Tissue Diseases (UCTD) 7 (7%) Psoriatic Arthritis (PsA) 5 (5%) Sjogren’s Syndrome (SS) 4 (4%) Spondylitis 3 (3%) Other (Sarcoidosis, Myositis, Osteoarthritis, Fibromyalgia, Uveitis, Vasculitis) 14 (14%) ConclusionsOur cohort showed high rate of patient satisfaction with telemedicine healthcare. However, the relatively low healthcare provider satisfaction rate raises concern as to whether elemedicine constitutes a satisfactory alternative to conventional in-person care. Additional researches are required to investigate the feasibility of telemedicine in long-term disease activity evaluation and patient outcome measurement.