Skip to main content
Log in

Belimumab and the Clinical Data

  • SYSTEMIC LUPUS ERYTHEMATOSUS (JT MERRILL, SECTION EDITOR)
  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

Benlysta (belimumab) is a fully human recombinant monoclonal IgG antibody that neutralizes soluble B-lymphocyte stimulator and inhibits its biologic activity. Benlysta was recently approved by the US Food and Drug Administration to treat systemic lupus erythematosus (SLE). The current review discusses the data from the belimumab clinical trials and the role of this new medication in the treatment of SLE. We propose that Benlysta should be used in antinuclear antibody–positive patients with active disease in whom the goal of therapy is to decrease SLE activity, reduce flares, and help lower background medications. With this being the first drug approved for treatment of SLE in 50 years, patients have more treatment options, while researchers have a greater understanding of SLE and clinical trial design in such a heterogeneous disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Urowitz M, Gladman D, Ibanez D, et al. Evolution of disease burden over 5 years in a multicentre inception SLE cohort. Arthritis Care Res (Hoboken) 2011.

  2. Lim SS, Drenkard C, McCune WJ, et al. Population-based lupus registries: advancing our epidemiologic understanding. Arthritis Rheum. 2009;61(10):1462–6.

    Article  PubMed  Google Scholar 

  3. Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997;40(9):1725.

    Article  PubMed  CAS  Google Scholar 

  4. Tan EM, Cohen AS, Fries JF, et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1982;25(11):1271–7.

    Article  PubMed  CAS  Google Scholar 

  5. Egner W. The use of laboratory tests in the diagnosis of SLE. J Clin Pathol. 2000;53(6):424–32.

    Article  PubMed  CAS  Google Scholar 

  6. ter Borg EJ, Horst G, Hummel EJ, et al. Measurement of increases in anti-double-stranded DNA antibody levels as a predictor of disease exacerbation in systemic lupus erythematosus. A long-term, prospective study. Arthritis Rheum. 1990;33(5):634–43.

    Article  PubMed  Google Scholar 

  7. Askanase AD, Wallace DJ, Weisman MH, et al. Use of pharmacogenetics, enzymatic phenotyping, and metabolite monitoring to guide treatment with azathioprine in patients with systemic lupus erythematosus. J Rheumatol. 2009;36(1):89–95.

    PubMed  CAS  Google Scholar 

  8. Carneiro JR, Sato EI. Double blind, randomized, placebo controlled clinical trial of methotrexate in systemic lupus erythematosus. J Rheumatol. 1999;26(6):1275–9.

    PubMed  CAS  Google Scholar 

  9. Ginzler EM, Dooley MA, Aranow C, et al. Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis. N Engl J Med. 2005;353(21):2219–28.

    Article  PubMed  CAS  Google Scholar 

  10. Baker KP, Edwards BM, Main SH, et al. Generation and characterization of LymphoStat-B, a human monoclonal antibody that antagonizes the bioactivities of B lymphocyte stimulator. Arthritis Rheum. 2003;48(11):3253–65.

    Article  PubMed  CAS  Google Scholar 

  11. Nashi E, Wang Y, Diamond B. The role of B cells in lupus pathogenesis. Int J Biochem Cell Biol. 2010;42(4):543–50.

    Article  PubMed  CAS  Google Scholar 

  12. Gross JA, Johnston J, Mudri S, et al. TACI and BCMA are receptors for a TNF homologue implicated in B-cell autoimmune disease. Nature. 2000;404(6781):995–9.

    Article  PubMed  CAS  Google Scholar 

  13. Moore PA, Belvedere O, Orr A, et al. BLyS: member of the tumor necrosis factor family and B lymphocyte stimulator. Science. 1999;285(5425):260–3.

    Article  PubMed  CAS  Google Scholar 

  14. Thompson JS, Bixler SA, Qian F, et al. BAFF-R, a newly identified TNF receptor that specifically interacts with BAFF. Science. 2001;293(5537):2108–11.

    Article  PubMed  CAS  Google Scholar 

  15. Zhang J, Roschke V, Baker KP, et al. Cutting edge: a role for B lymphocyte stimulator in systemic lupus erythematosus. J Immunol. 2001;166(1):6–10.

    PubMed  CAS  Google Scholar 

  16. Petri M, Stohl W, Chatham W, et al. Association of plasma B lymphocyte stimulator levels and disease activity in systemic lupus erythematosus. Arthritis Rheum. 2008;58(8):2453–9.

    Article  PubMed  CAS  Google Scholar 

  17. Furie R, Stohl W, Ginzler EM, et al. Biologic activity and safety of belimumab, a neutralizing anti-B-lymphocyte stimulator (BLyS) monoclonal antibody: a phase I trial in patients with systemic lupus erythematosus. Arthritis Res Ther. 2008;10(5):R109.

    Article  PubMed  Google Scholar 

  18. Wallace DJ, Stohl W, Furie RA, et al. A phase II, randomized, double-blind, placebo-controlled, dose-ranging study of belimumab in patients with active systemic lupus erythematosus. Arthritis Rheum. 2009;61(9):1168–78.

    Article  PubMed  CAS  Google Scholar 

  19. Furie RA, Petri MA, Wallace DJ, et al. Novel evidence-based systemic lupus erythematosus responder index. Arthritis Rheum. 2009;61(9):1143–51.

    Article  PubMed  CAS  Google Scholar 

  20. Jacobi AM, Huang W, Wang T, et al. Effect of long-term belimumab treatment on B cells in systemic lupus erythematosus: extension of a phase II, double-blind, placebo-controlled, dose-ranging study. Arthritis Rheum. 2010;62(1):201–10.

    Article  PubMed  CAS  Google Scholar 

  21. • Furie R, Petri M, Zamani O, et al. A phase III, randomized, placebo-controlled study of belimumab, a monoclonal antibody that inhibits B lymphocyte stimulator, in patients with systemic lupus erythematosus. Arthritis Rheum. 2011;63(12):3918–30. This publication describes results of one of the phase 3, international, randomized controlled clinical trials of belimumab plus standard of care in active SLE patients. This study met its primary end point, showing efficacy of belimumab at 52 weeks using the SRI. It was also shown that the rates of AEs, serious AEs, and infections in the belimumab groups were not significantly different from those of the placebo group.

    Article  PubMed  CAS  Google Scholar 

  22. • Navarra SV, Guzman RM, Gallacher AE, et al. Efficacy and safety of belimumab in patients with active systemic lupus erythematosus: a randomised, placebo-controlled, phase 3 trial. Lancet. 2011;377(9767):721–31. This publication describes results of one of the phase 3, international, randomized controlled clinical trials of belimumab plus standard of care in active SLE patients. This study met its primary end point, showing efficacy of belimumab at 52 weeks using the SRI. It was also shown that the rates of AEs, serious AEs, and infections in the belimumab groups were not significantly different from those of the placebo group.

    Article  PubMed  CAS  Google Scholar 

  23. Stohl W, Hiepe F, Latinis KM, et al. Belimumab reduces autoantibodies, normalizes low complement, and reduces select B-cell populations in patients with systemic lupus erythematosus. Arthritis Rheum 2012.

  24. van Vollenhoven RF, Petri MA, Cervera R, et al. Belimumab in the treatment of systemic lupus erythematosus: high disease activity predictors of response. Ann Rheum Dis 2012.

  25. • Chowdhury BA. FDA briefing information BLA 125370; Benlysta (belimumab), A.A. Committee, Editor. 2010. This publication describes and summarizes the safety of all the belimumab trials completed, including long-term extension follow-up in SLE patients.

  26. Bernatsky S, Boivin JF, Joseph L, et al. Mortality in systemic lupus erythematosus. Arthritis Rheum. 2006;54(8):2550–7.

    Article  PubMed  CAS  Google Scholar 

  27. Bernatsky S, Boivin JF, Joseph L, et al. An international cohort study of cancer in systemic lupus erythematosus. Arthritis Rheum. 2005;52(5):1481–90.

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosure

Dr. Askanase has served as a principal investigator for belimumab clinical trials.

Katrina Shum reported no potential conflicts of interest relevant to this article.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Anca Askanase.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shum, K., Askanase, A. Belimumab and the Clinical Data. Curr Rheumatol Rep 14, 310–317 (2012). https://doi.org/10.1007/s11926-012-0264-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11926-012-0264-4

Keywords

Navigation