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Successful sequential therapy with rituximab and belimumab in patients with active systemic lupus erythematosus: a case series

1, 2, 3, 4, 5, 6, 7

  1. Lupus Clinic, Division of Rheumatology, ASST Pini, Department of Clinical Sciences and Community Health, University of Milan, Italy. roberta.gualtierotti@unimi.it
  2. Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, IRCCS, Milan, Italy.
  3. Lupus Clinic, Division of Rheumatology, ASST Pini, Department of Clinical Sciences and Community Health, University of Milan, Italy.
  4. Lupus Clinic, Division of Rheumatology, ASST Pini, Department of Clinical Sciences and Community Health, University of Milan, Italy.
  5. Istituto Nazionale Genetica Molecolare 'Romeo ed Enrica Invernizzi', Milan; Department of Pathophysiology and Transplantation, University of Milan, Italy.
  6. Istituto Nazionale Genetica Molecolare 'Romeo ed Enrica Invernizzi', Milan, Italy.
  7. Lupus Clinic, Division of Rheumatology, ASST Pini, Department of Clinical Sciences and Community Health, University of Milan; Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, IRCCS, Milan, Italy.

CER10680 Submission on line
2018 Vol.36, N°4 - PI 0643, PF 0647
Brief Papers

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Rheumatology Article

 

Abstract

OBJECTIVES:
B cells play an important role in the initiation and progression of systemic lupus erythematosus (SLE). Accordingly, B cell-targeted therapy has been suggested as a new rational approach for treating lupus. Belimumab, a human monoclonal antibody directed against B lymphocyte stimulator (BLyS), was reported as the first biological treatment effective in reducing mild-to-moderate SLE disease activity by using different scoring systems and endpoints. Conversely clinical trials with rituximab, a chimeric monoclonal antibody directed against the CD20 expressed by B cells, have failed to achieve primary endpoints in spite of a number of reports showing its beneficial effects. Anecdotal reports have described the sequential use of rituximab and belimumab as a more effective treatment than using the individual drugs alone, without compromising safety.
METHODS:
We report a case series of three patients with active SLE refractory to conventional therapies, who underwent treatment with rituximab followed by belimumab as maintenance therapy.
RESULTS:
We observed a beneficial effect after sequential treatment with rituximab and belimumab. All patients achieved long-standing remission and could reduce or discontinue corticosteroids. Concomitantly, after rituximab administration we observed a rise in BLyS levels, which were dramatically reduced after belimumab introduction.
CONCLUSIONS:
The modulation of plasma BLyS kinetics in patients undergoing sequential treatment with rituximab and belimumab may represent a possible rationale behind the effectiveness of this combined therapy.

PMID: 29533753 [PubMed]

Received: 11/07/2017 - Accepted : 11/09/2017 - In Press: 27/02/2018 - Published: 19/07/2018