Objective. 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. Conclusion. 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.
Successful sequential therapy with rituximab and belimumab in patients with active systemic lupus erythematosus: a case series / R. Gualtierotti, M.O. Borghi, M. Gerosa, T. Schioppo, P. Larghi, J. Geginat, P.L. Meroni. - In: CLINICAL AND EXPERIMENTAL RHEUMATOLOGY. - ISSN 0392-856X. - 36:4(2018 Jul), pp. 643-647.
|Titolo:||Successful sequential therapy with rituximab and belimumab in patients with active systemic lupus erythematosus: a case series|
|Parole Chiave:||systemic lupus erythematosus; B cells; rituximab; belimumab; therapy; BLyS; BAFF; biologics; biological|
|Settore Scientifico Disciplinare:||Settore MED/16 - Reumatologia|
|Data di pubblicazione:||lug-2018|
|Data ahead of print / Data di stampa:||lug-2018|
|Appare nelle tipologie:||01 - Articolo su periodico|