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Abstract
Objective The risk of progression to end stage kidney disease (ESKD) following identification of Lupus nephritis (LN) is 10–30 %, this risk has remained unchanged for decades. The landmark BLISS-LN trial led to belimumab being the first FDA approved drug for patients with active LN. We present our case series of LN patients treated with belimumab after previous treatment resistance with cyclophosphamide and/or rituximab.
Methods All patients who had biopsy proven LN with class III or above and received belimumab were prospectively recorded. Case notes were reviewed and outcomes at 1 year were analysed. Key outcome measures that were studied at 1 year were eGFR, urine protein creatinine ratio (uPCR), and SLEDAI-2K score.
Results 11 patients with biopsy proven LN were treated with belimumab. 10/11 (90%) patients were female, 8/11 (72%) were of black ethnicity, median age at diagnosis and duration of disease was 22 years and 72 months respectively. 10/11 (90%) patients received cyclophosphamide and 8/11 (72%) had rituximab prior to belimumab treatment. All patients had treatment with MMF, steroids and hydroxychloroquine. At initiation of therapy median eGFR was 52mL/min, uPCR 1.64 g/mmol, SLEDAI-2K score was 16. One patient had commenced haemodialysis at the time of treatment. At 1 year 7/10 (70%) patients did not see a fall in eGFR of greater than 20%, 5/10 (50%) had a uPCR < 1g/mmol, 1 person commenced dialysis and 1 person died. Markers of disease activity improved with a median SLEDAI-2K score of 8. The one patient on haemodialysis was able to successfully receive a kidney transplant.
Conclusions The data presented here shows successful real world experience of belimumab in patients who showed features of relapse in disease activity having previously had cyclophosphamide or rituximab. The cohort was predominately black with lower median eGFR and longer duration of disease. Despite this, good 1 year outcomes of renal markers were seen and with an improvement in overall disease activity. Belimumab therapy represents real promise in decreasing progression to ESKD in LN.
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