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Objectives Organ damage prevention is a key treatment goal in SLE. Belimumab selectively inhibits B lymphocyte stimulator, reduces autoreactive B cells that drive SLE disease activity, and slows damage progression. Real-world evidence on damage predictors is limited; identifying predictors may help target patients needing early treatment escalation. We identified predictors of time to damage in any organ system among belimumab-treated patients with SLE.Methods This retrospective, longitudinal cohort study (GSK Study 300208) used administrative healthcare claims data from the Komodo Research Database (USA) to identify patients aged >=18 years who initiated belimumab (index date) during 1/1/2017–6/30/2023 after SLE diagnosis. Patients had continuous enrolment for >=24 months pre-index (baseline period: 12 months pre-index) and >=12 months post-index. Patients with lupus nephritis or drug-induced lupus pre-index, baseline biologic use or baseline damage were excluded. Stepwise Cox proportional hazards regression models (using Akaike Information Criterion) assessed the predictive value of candidate baseline covariates (see figure 1 for definitions) for new damage in any organ system domain over 6 and 12 months post-index. Early versus late belimumab use was defined as without versus with immunosuppressant use during baseline, respectively.Results 1639 patients were included. Median age was ~44 years and 64.7% were early belimumab users ( table 1). Age at index >=44 (vs <44) years (hazard ratio [95% confidence interval]: 1.27 [0.91, 1.77]), Northeast (vs South) USA region (1.15 [0.79, 1.67]), higher Quan-Charlson Comorbidity Index (Quan-CCI) (1.23 [1.05, 1.43]), and early (vs late) belimumab use (0.68 [0.49, 0.94]) were damage predictors over 6 months (figure 1). Damage predictors over 12 months were: age at index >=44 (vs <44) years (1.33 [1.04, 1.71]), unknown race (vs white) (0.78 [0.56, 1.08]), West (vs South) USA region (0.68 [0.44, 1.04]), higher Quan-CCI (1.16 [1.02, 1.31]), more baseline comorbidities (1.10 [1.03, 1.16]), and early (vs late) belimumab use (0.79 [0.62, 1.01]) (figure 1). Damage occurred in 7.6% of early belimumab users versus 10.9% of late belimumab users over 6 months, and in 15.0% versus 18.5% over 12 months.Abstract PO:03:089 Table 1Demographic and clinical characteristics of patients with SLE during baseline 12 months prior to the index date of belimumab initiationAbstract PO:03:089 Figure 1Predictors of time to organ damage* at (A) 6 months and (B) 12 months among 1639 patients with SLE initiating belimumabConclusions This hypothesis-generating study suggests that early belimumab use may rapidly delay damage in SLE. Future research is needed to confirm results and inform clinical decisions.Funding GSK