Rituximab Followed by Belimumab Controls Severe Lupus Nephritis and Bullous Pemphigoid in Systemic Lupus Erythematosus Refractory to Several Combination Therapies

Frontiers in Medicine

article

Luca Petricca¹  Stefano Alivernini²  Giuseppe Grandaliano³  Gianfranco Ferraccioli²  Elisa Gremese¹  Maria Rita Gigante¹  Annamaria Paglionico¹  Stefano Costanzi³  Gisella Vischini³  Clara Di Mario²  Valentina Varriano²  Giacomo Tanti²  Barbara Tolusso¹ 

[1] Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS;Division of Rheumatology, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore;Nephrology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS;Nephrology Unit, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore

关键词: lupus nephritis;    bullous pemphigoid;    belimumab;    rituximab;    sequential therapy;   

DOI  :  10.3389/fmed.2020.553075

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Systemic lupus erythematosus (SLE) and bullous pemphigoid (BP) are chronic autoimmune diseases in which B cells play an important pathogenic role in the different stages of the disease. B cell-targeted therapies have been suggested as a new rational approach for treating SLE. Rituximab (RTX), an anti-CD20 chimeric monoclonal antibody, failed to achieve primary endpoints in two clinical trials (EXPLORER and LUNAR) despite multiple observational and retrospective studies showing its beneficial effect on SLE. Moreover, RTX is recommended in cases of BP that is unresponsive to conventional treatments. Belimumab (BLM), a human immunoglobulin G1 λ monoclonal antibody that inhibits soluble B-lymphocyte stimulator (BlyS)/B-cell activating factor (BAFF), is the only biological treatment approved for standard therapy of refractory autoantibody-positive active SLE. Animal models and a few case reports have supported the efficacy of the combined use of RTX followed by BLM as maintenance therapy in severe lupus nephritis (LN), suggesting that their combined use may be more effective than their single use, without compromising safety. In this study, we describe the clinical case of a SLE patient with predominant renal involvement in overlap with BP, refractory to conventional therapy including RTX alone, achieving significant steroid sparing and clinical remission under sequential treatment of RTX-BLM. Moreover, we describe the first case of BP successfully treated with BLM. This case report may encourage further clinical research studies in B lymphocyte targeted combination therapy in patients affected by SLE with major organ involvement or with refractory disease, suggesting that RTX and BLM sequential therapy may be a valid option for the treatment of SLE manifestations, including conventional therapy and RTX-resistant LN.

【 授权许可】

CC BY