Brief Papers
Successful sequential therapy with rituximab and belimumab in patients with active systemic lupus erythematosus: a case series
R. Gualtierotti1, M.O. Borghi2, M. Gerosa3, T. Schioppo4, P. Larghi5, J. Geginat6, P.L. Meroni7
- Lupus Clinic, Division of Rheumatology, ASST Pini, Department of Clinical Sciences and Community Health, University of Milan, Italy. roberta.gualtierotti@unimi.it
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, IRCCS, Milan, Italy.
- Lupus Clinic, Division of Rheumatology, ASST Pini, Department of Clinical Sciences and Community Health, University of Milan, Italy.
- Lupus Clinic, Division of Rheumatology, ASST Pini, Department of Clinical Sciences and Community Health, University of Milan, Italy.
- Istituto Nazionale Genetica Molecolare 'Romeo ed Enrica Invernizzi', Milan; Department of Pathophysiology and Transplantation, University of Milan, Italy.
- Istituto Nazionale Genetica Molecolare 'Romeo ed Enrica Invernizzi', Milan, Italy.
- 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
2018 Vol.36, N°4
PI 0643, PF 0647
Brief Papers
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PMID: 29533753 [PubMed]
Received: 11/07/2017
Accepted : 11/09/2017
In Press: 27/02/2018
Published: 19/07/2018
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.