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Belimumab may decrease flare rate and allow glucocorticoid withdrawal in lupus nephritis (including dialysis and transplanted patient)

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Abstract

Background

Belimumab (Benlysta) is currently approved for the treatment of active Lupus despite standard therapy. Few data are available on the efficacy of this drug in lupus nephritis (LN).

Methods

17 LN female followed in two Nephrology Italian Unit received belimumab for a median period of 36 months (range 6–42 months). The indications were: arthralgia in 3 patients, cutaneous manifestations in 2, residual proteinuria in 8, and the need to reduce steroids for severe side effects in 4. Of interest, 1 patient started therapy during Peritoneal Dialysis and continued after kidney transplantation due to non-responsive arthralgias.

Results

Arthralgia and skin manifestations resolved in all patients. Proteinuria normalized in three patients and stabilized in all but one of the others. Steroids were indefinitely stopped in six patients (35%) and reduced to around 40% of the basal dosage in the other patients. During belimumab therapy, three extrarenal and one renal SLE flares were diagnosed accounting for a rate of renal flares of 0.02/patient/year. No major adverse events leading to therapy withdrawal occurred.

Clinical case

Arthralgia resolved, immunological parameters improved and prednisone could be reduced within few months in the patient who started belimumab during peritoneal dialysis. After kidney transplantation belimumab was stopped but due to arthralgias unresponsive to standard immunosuppressive therapy it was restarted with success.

Conclusions

Belimumab allows the achievement of complete response together with the withdrawal or the reduction of corticosteroids in almost all our patients. Of interest its satisfactory use in a patient in peritoneal dialysis and after kidney transplantation.

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Author notes

  1. Renato Alberto Sinico and Gabriella Moroni are equally contributing senior authors.

Authors and Affiliations

  1. Divisione Di Nefrologia E Dialisi-Padiglione Croff, Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico Di Milano, via della Commenda 15, 20122, Milan, Italy

    Valentina Binda, Giulia Frontini, Giulia Porata, Piergiorgio Messa & Gabriella Moroni

  2. Nephrology Unit, Department of Medicine and Surgery, University of Milano-Bicocca and ASST Monza, Monza, Italy

    Barbara Trezzi, Paolo Fabbrini & Renato Alberto Sinico

  3. U.O.C. Day Hospital Reumatologia, ASST G. Pini-CTO, Milan, Italy

    Nicoletta Del Papa

  4. Referral Center for Systemic Autoimmune Diseases, Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico Di Milano, Milan, Italy

    Lorenzo Beretta

  5. Rheumatology Unit, ASST-Monza, Monza, Italy

    Maria Rosa Pozzi

Authors
  1. Valentina Binda
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  2. Barbara Trezzi
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Contributions

All authors contributed to the study conception and design. Research idea and study design: GM and RAS. Data acquisition: VB, BT, GF, GP and PF. Data analysis/interpretation: GM, NDP, LB and MRP. Supervision or mentorship: GM, RAS, PM. Each author contributed important intellectual content during manuscript drafting or revision. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Valentina Binda.

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Conflict of interest

The authors report no conflict of interest.

Ethical approval

The study was approved by the Ethics Committee of Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico di Milano, Italy (protocol number 504_2019bis).

Research involving human participants and/or animals and informed consent

The study was conducted according to the Declaration of Helsinki and informed consent was given to all patients that participated in the study.

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Binda, V., Trezzi, B., Del Papa, N. et al. Belimumab may decrease flare rate and allow glucocorticoid withdrawal in lupus nephritis (including dialysis and transplanted patient). J Nephrol 33, 1019–1025 (2020). https://doi.org/10.1007/s40620-020-00706-3

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  • DOI: https://doi.org/10.1007/s40620-020-00706-3

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