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Published in: Trials 1/2020

Open Access 01-12-2020 | Systemic Lupus Erythematosus | Update

Safety and efficacy of belimumab after B cell depletion therapy in systemic LUPUS erythematosus (BEAT-LUPUS) trial: statistical analysis plan

Authors: Patrick Muller, Kashfia Chowdhury, Caroline Gordon, Michael R. Ehrenstein, Caroline J. Doré

Published in: Trials | Issue 1/2020

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Abstract

Background

There is limited evidence that rituximab, a B cell depletion therapy, is an effective treatment for systemic lupus erythematosus (SLE). Data on the mechanisms of B cell depletion in SLE indicate that the combination of rituximab and belimumab may be more effective than rituximab alone. The safety and efficacy of belimumab after B cell depletion therapy in systemic LUPUS erythematosus (BEAT-LUPUS) trial aims to determine whether belimumab is superior to placebo, when given 4–8 weeks after treatment with rituximab. This article describes the statistical analysis plan for this trial as an update to the published protocol. It is written prior to the end of patient follow-up, while the outcome of the trial is still unknown.

Design and methods

BEAT-LUPUS is a randomised, double-blind, phase II trial of 52 weeks of belimumab versus placebo, initiated 4–8 weeks after rituximab treatment. The primary outcome is anti-dsDNA antibodies at 52 weeks post randomisation. Secondary outcomes include lupus flares and damage, adverse events, doses of concomitant medications, quality of life, and clinical biomarkers. We describe the trial’s clinical context, outcome measures, sample size calculation, and statistical modelling strategy, and the supportive analyses planned to evaluate for mediation of the treatment effect through changes in concomitant medication doses and bias from missing data.

Discussion

The analysis will provide detailed information on the safety and effectiveness of belimumab. It will be implemented from July 2020 when patient follow-up and data collection is complete.

Trial registration

ISRCTN: 47873003. Registered on 28 November 2016.
EudracT: 2015-005543-14. Registered on 19 November 2018.
Appendix
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Literature
1.
go back to reference Thomas G, Mancini J, Jourde-Chiche N, Sarlon G, Amoura Z, Harle JR, et al. Mortality associated with systemic lupus erythematosus in France assessed by multiple-cause-of-death analysis. Arthritis Rheumatol (Hoboken, NJ). 2014;66(9):2503–11.CrossRef Thomas G, Mancini J, Jourde-Chiche N, Sarlon G, Amoura Z, Harle JR, et al. Mortality associated with systemic lupus erythematosus in France assessed by multiple-cause-of-death analysis. Arthritis Rheumatol (Hoboken, NJ). 2014;66(9):2503–11.CrossRef
2.
go back to reference Ruiz-Irastorza G, Danza A, Khamashta M. Glucocorticoid use and abuse in SLE. Rheumatology (Oxford). 2012;51(7):1145–53.CrossRef Ruiz-Irastorza G, Danza A, Khamashta M. Glucocorticoid use and abuse in SLE. Rheumatology (Oxford). 2012;51(7):1145–53.CrossRef
3.
go back to reference Ahmad Y, Shelmerdine J, Bodill H, Lunt M, Pattrick MG, Teh LS, et al. Subclinical atherosclerosis in systemic lupus erythematosus (SLE): the relative contribution of classic risk factors and the lupus phenotype. Rheumatology (Oxford). 2007;46(6):983–8.CrossRef Ahmad Y, Shelmerdine J, Bodill H, Lunt M, Pattrick MG, Teh LS, et al. Subclinical atherosclerosis in systemic lupus erythematosus (SLE): the relative contribution of classic risk factors and the lupus phenotype. Rheumatology (Oxford). 2007;46(6):983–8.CrossRef
4.
go back to reference Lazarus MN, Turner-Stokes T, Chavele K-M, Isenberg DA, Ehrenstein MR. B-cell numbers and phenotype at clinical relapse following rituximab therapy differ in SLE patients according to anti-dsDNA antibody levels. Rheumatology (Oxford, England). 2012;51(7):1208–15.CrossRef Lazarus MN, Turner-Stokes T, Chavele K-M, Isenberg DA, Ehrenstein MR. B-cell numbers and phenotype at clinical relapse following rituximab therapy differ in SLE patients according to anti-dsDNA antibody levels. Rheumatology (Oxford, England). 2012;51(7):1208–15.CrossRef
5.
go back to reference Favas C, Isenberg DA. B-cell-depletion therapy in SLE—what are the current prospects for its acceptance? Nat Rev Rheumatol. 2009;5(12):711–6.CrossRef Favas C, Isenberg DA. B-cell-depletion therapy in SLE—what are the current prospects for its acceptance? Nat Rev Rheumatol. 2009;5(12):711–6.CrossRef
6.
go back to reference Carter LM, Isenberg DA, Ehrenstein MR. Elevated serum BAFF levels are associated with rising anti-double-stranded DNA antibody levels and disease flare following B cell depletion therapy in systemic lupus erythematosus. Arthritis Rheum. 2013;65(10):2672–9.PubMed Carter LM, Isenberg DA, Ehrenstein MR. Elevated serum BAFF levels are associated with rising anti-double-stranded DNA antibody levels and disease flare following B cell depletion therapy in systemic lupus erythematosus. Arthritis Rheum. 2013;65(10):2672–9.PubMed
7.
go back to reference Jones A, Muller P, Dore CJ, Ikeji F, Caverly E, Chowdhury K, et al. Belimumab after B cell depletion therapy in patients with systemic lupus erythematosus (BEAT Lupus) protocol: a prospective multicentre, double-blind, randomised, placebo-controlled, 52-week phase II clinical trial. BMJ Open. 2019;9(12):e032569.CrossRef Jones A, Muller P, Dore CJ, Ikeji F, Caverly E, Chowdhury K, et al. Belimumab after B cell depletion therapy in patients with systemic lupus erythematosus (BEAT Lupus) protocol: a prospective multicentre, double-blind, randomised, placebo-controlled, 52-week phase II clinical trial. BMJ Open. 2019;9(12):e032569.CrossRef
8.
go back to reference Stata Corp. Stata Statistical software: Release 15. College Station: StataCorp LLC; 2017. Stata Corp. Stata Statistical software: Release 15. College Station: StataCorp LLC; 2017.
9.
go back to reference Borm GF, Fransen J, Lemmens WA. A simple sample size formula for analysis of covariance in randomized clinical trials. J Clin Epidemiol. 2007;60(12):1234–8.CrossRef Borm GF, Fransen J, Lemmens WA. A simple sample size formula for analysis of covariance in randomized clinical trials. J Clin Epidemiol. 2007;60(12):1234–8.CrossRef
10.
go back to reference Schulz KF, Altman DG, Moher D. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMJ (Clinical research ed). 2010;340:c332. Schulz KF, Altman DG, Moher D. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMJ (Clinical research ed). 2010;340:c332.
11.
go back to reference Yee C-S, Cresswell L, Farewell V, Rahman A, Teh L-S, Griffiths B, et al. Numerical scoring for the BILAG-2004 index. Rheumatology (Oxford, England). 2010;49(9):1665–9.CrossRef Yee C-S, Cresswell L, Farewell V, Rahman A, Teh L-S, Griffiths B, et al. Numerical scoring for the BILAG-2004 index. Rheumatology (Oxford, England). 2010;49(9):1665–9.CrossRef
12.
go back to reference Isenberg DA, Allen E, Farewell V, D'Cruz D, Alarcón GS, Aranow C, et al. An assessment of disease flare in patients with systemic lupus erythematosus: a comparison of BILAG 2004 and the flare version of SELENA. Ann Rheum Dis. 2011;70(1):54–9.CrossRef Isenberg DA, Allen E, Farewell V, D'Cruz D, Alarcón GS, Aranow C, et al. An assessment of disease flare in patients with systemic lupus erythematosus: a comparison of BILAG 2004 and the flare version of SELENA. Ann Rheum Dis. 2011;70(1):54–9.CrossRef
13.
go back to reference Isenberg D, Sturgess J, Allen E, Aranow C, Askanase A, Sang-Cheol B, et al. Study of flare assessment in systemic lupus erythematosus based on paper patients. Arthritis Care Res. 2018;70(1):98–103.CrossRef Isenberg D, Sturgess J, Allen E, Aranow C, Askanase A, Sang-Cheol B, et al. Study of flare assessment in systemic lupus erythematosus based on paper patients. Arthritis Care Res. 2018;70(1):98–103.CrossRef
14.
go back to reference Bombardier C, Gladman DD, Urowitz MB, Caron D, Chang CH, Austin A, et al. Derivation of the SLEDAI. A disease activity index for lupus patients. Arthritis Rheum. 1992;35(6):630–40.CrossRef Bombardier C, Gladman DD, Urowitz MB, Caron D, Chang CH, Austin A, et al. Derivation of the SLEDAI. A disease activity index for lupus patients. Arthritis Rheum. 1992;35(6):630–40.CrossRef
15.
go back to reference Gladman DD, Urowitz MB, Goldsmith CH, Fortin P, Ginzler E, Gordon C, et al. The reliability of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index in patients with systemic lupus erythematosus. Arthritis Rheum. 1997;40(5):809–13.CrossRef Gladman DD, Urowitz MB, Goldsmith CH, Fortin P, Ginzler E, Gordon C, et al. The reliability of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index in patients with systemic lupus erythematosus. Arthritis Rheum. 1997;40(5):809–13.CrossRef
16.
go back to reference McElhone K, Abbott J, Shelmerdine J, Bruce IN, Ahmad Y, Gordon C, et al. Development and validation of a disease-specific health-related quality of life measure, the LupusQol, for adults with systemic lupus erythematosus. Arthritis Care Res. 2007;57(6):972–9.CrossRef McElhone K, Abbott J, Shelmerdine J, Bruce IN, Ahmad Y, Gordon C, et al. Development and validation of a disease-specific health-related quality of life measure, the LupusQol, for adults with systemic lupus erythematosus. Arthritis Care Res. 2007;57(6):972–9.CrossRef
17.
go back to reference Rand Corporation. 36-Item Short Form Survey (SF-36). Santa Monica: RAND Corporation; 1988. Rand Corporation. 36-Item Short Form Survey (SF-36). Santa Monica: RAND Corporation; 1988.
18.
go back to reference Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20(10):1727–36.CrossRef Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20(10):1727–36.CrossRef
19.
go back to reference Posner K, Brown GK, Stanley B, Brent DA, Yershova KV, Oquendo MA, et al. The Columbia–Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatr. 2011;168(12):1266–77.CrossRef Posner K, Brown GK, Stanley B, Brent DA, Yershova KV, Oquendo MA, et al. The Columbia–Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatr. 2011;168(12):1266–77.CrossRef
20.
go back to reference Bruce B, Fries JF. The Stanford Health Assessment Questionnaire: dimensions and practical applications. Health Qual Life Outcomes. 2003;1:20.CrossRef Bruce B, Fries JF. The Stanford Health Assessment Questionnaire: dimensions and practical applications. Health Qual Life Outcomes. 2003;1:20.CrossRef
21.
go back to reference Gordon C, Sutcliffe N, Skan J, Stoll T, Isenberg DA. Definition and treatment of lupus flares measured by the BILAG index. Rheumatology. 2003;42(11):1372–9.CrossRef Gordon C, Sutcliffe N, Skan J, Stoll T, Isenberg DA. Definition and treatment of lupus flares measured by the BILAG index. Rheumatology. 2003;42(11):1372–9.CrossRef
22.
go back to reference Gladman D, Ginzler E, Goldsmith C, Fortin P, Liang M, Sanchez-Guerrero J, et al. The development and initial validation of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index for systemic lupus erythematosus. Arthritis Rheum. 1996;39(3):363–9.CrossRef Gladman D, Ginzler E, Goldsmith C, Fortin P, Liang M, Sanchez-Guerrero J, et al. The development and initial validation of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index for systemic lupus erythematosus. Arthritis Rheum. 1996;39(3):363–9.CrossRef
23.
go back to reference Columbia-Suicide Severity Rating Scale scoring and data analysis guide. Columbia University: The Columbia Lighthouse Project; 2013. Columbia-Suicide Severity Rating Scale scoring and data analysis guide. Columbia University: The Columbia Lighthouse Project; 2013.
24.
go back to reference Imai K, Keele L, Tingley D. A general approach to causal mediation analysis. Psychol Methods. 2010;15(4):309–34.CrossRef Imai K, Keele L, Tingley D. A general approach to causal mediation analysis. Psychol Methods. 2010;15(4):309–34.CrossRef
25.
go back to reference Hicks R, Tingley D. Causal mediation analysis. Stata J. 2011;11(4):605–19.CrossRef Hicks R, Tingley D. Causal mediation analysis. Stata J. 2011;11(4):605–19.CrossRef
26.
go back to reference Graham JW, Olchowski AE, Gilreath TD. How many imputations are really needed? Some practical clarifications of multiple imputation theory. Prev Sci. 2007;8(3):206–13.CrossRef Graham JW, Olchowski AE, Gilreath TD. How many imputations are really needed? Some practical clarifications of multiple imputation theory. Prev Sci. 2007;8(3):206–13.CrossRef
27.
go back to reference Carpenter J, Kenward M. Multiple imputation and its application. Chichester: Wiley; 2013.CrossRef Carpenter J, Kenward M. Multiple imputation and its application. Chichester: Wiley; 2013.CrossRef
Metadata
Title
Safety and efficacy of belimumab after B cell depletion therapy in systemic LUPUS erythematosus (BEAT-LUPUS) trial: statistical analysis plan
Authors
Patrick Muller
Kashfia Chowdhury
Caroline Gordon
Michael R. Ehrenstein
Caroline J. Doré
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Trials / Issue 1/2020
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-020-04391-2

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