Background Belimumab, a human IgG1 monoclonal antibody, inhibits the binding of soluble B lymphocyte stimulator to B cells. It is approved for renal and non-renal SLE and as an add-on therapy. Belimumab was only made available in Singapore in Jan 2022, and we hope that it will be a potential disease-modifying and disease-remitting lupus biologic therapy.
Methods We reviewed and analysed our initial experience with belimumab therapy in 6 SLE patients as an add-on and/or sequential therapy after rituximab since the start of Jan 2022 till Jan 2023
Results All 6 patients were female, age range 21–64 years old, with 3 Chinese, 1 Malay, and 2 Cambodian. Disease duration ranged from few months to 4 years. 2 had renal
Involvement, and one patient has SLE/APS.
Concomitant medications includes prednisolone(6 patients). tacrolimus( 4 patients), mycophenolate ( 2 patients), baricitinib ( 4 patients), hydroxychloroquine ( 4 patients). 3 patients had sequential rituximab -belimumab therapy.
IV belimumab infusion was very well tolerated without any adverse events
Number of infusions completed ranged from 2–11( average 7).
Disease stability, reduction of steroid doses and severity of flares were observed in this small case series of patients.
Conclusions Belimumab is a useful disease-modifying and disease-remitting therapy that can be added-on to the standard lupus therapy with minimal adverse effects. More patients and longer follow-up period will be needed to gain a wider clinical patient experience.
JA Singh, et al. Belimumab for systemic lupus erythematosus. Cochrane Database Syst Rev 2021 Feb 25;2(2):CD010668
Urowitz, et al. Impact of Belimumab on Organ Damage in Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2022 Nov;74(11):1822–1828
M Shipa, et al. Effectiveness of Belimumab After Rituximab in Systemic Lupus Erythematosus : A Randomized Controlled Trial. Ann Intern Med 2021 Dec;174(12):1647–1657
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