Belimumab may decrease flare rate and allow glucocorticoid withdrawal in lupus nephritis (including dialysis and transpl
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ORIGINAL ARTICLE
Belimumab may decrease flare rate and allow glucocorticoid withdrawal in lupus nephritis (including dialysis and transplanted patient) Valentina Binda1 · Barbara Trezzi2 · Nicoletta Del Papa3 · Lorenzo Beretta4 · Giulia Frontini1 · Giulia Porata1 · Paolo Fabbrini2 · Maria Rosa Pozzi5 · Piergiorgio Messa1 · Renato Alberto Sinico2 · Gabriella Moroni1 Received: 31 October 2019 / Accepted: 16 January 2020 © Italian Society of Nephrology 2020
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. Keywords Systemic lupus erythematosus · SLE · Belimumab · Lupus nephritis · Kidney transplantation
Introduction
Renato Alberto Sinico and Gabriella Moroni are equally contributing senior authors. * Valentina Binda [email protected] 1
2
Divisione Di Nefrologia E Dialisi‑Padiglione Croff, Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico Di Milano, via della Commenda 15, 20122 Milan, Italy
Systemic lupus erythematosus (SLE) is an autoimmune condition of unknown etiology that affects a variety of organ systems [1]. Conventional therapies for the treatment of SLE include antimalarials, NSAIDs, steroids and 3
U.O.C. Day Hospital Reumatologia, ASST G. Pini-CTO, Milan, Italy
4
Referral Center for Systemic Autoimmune Diseases, Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico Di Milano, Milan, Italy
5
Rheum
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