EXPERIENCE WITH BELIMUMAB IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Abstract

Objective: to investigate the efficacy of an anti-BlyS drug (belimumab) for the treatment of systemic lupus erythematous (SLE). Subjects and methods. Belimumab (BLM) was administered to three patients with SLE (two women and one man were aged 24, 28, and 39 years, respectively). SLE activity was estimated according to the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)-2K, the values of which were 8, 12, and 14 scores, respectively, due to high immunological activity, skin, joint, and mucosal lesions. The high Systemic Lupus International Collaborating Clinics (SLICC) Damage Index score of 3 was found in 2 of the 3 patients. All patients received glucocorticoids (GC) 20–25 mg/day; two – hydroxychloroquine and one – mycophenolate mofetil 1000 mg/day. Therapy with BLM was performed using a standard scheme: three 10 mg/kg infusions during the first month, then one infusion every month. Results. Positive clinical changes were noted 2 months after therapy initiation; symptoms completely disappeared 3 and 6 months later. Anti-DNA antibodies and complement fractions, the levels of which were partially normalized at 2 to 9 months of treatment, were most refractory to BLM therapy. During the follow-up, there were no SLE exacerbations; the dose of GC could be halved in two cases. Glomerular filtration normalized in one patient with inactive lupus nephritis. Conclusion. BLM treatment is justified in patients with moderate SLE activity in the presence of polyarthritis, serositis, skin and mucosal lesions and with high immunological activity. The use of BLM is not contraindicated in patients with inactive lupus nephritis without obvious kidney dysfunction. The additional motivation to use BLM may be an inadequately high GC dose, a recurrent disease course, insufficient therapeutic efficiency, and a risk for irreversible organ damages