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

Frontiers in Medicine

Giacomo Tanti¹  Gianfranco Ferraccioli¹  Elisa Gremese¹  Stefano Alivernini¹  Valentina Varriano¹  Clara Di Mario¹  Luca Petricca²  Barbara Tolusso²  Maria Rita Gigante²  Annamaria Paglionico²  Giuseppe Grandaliano³  Gisella Vischini⁴  Stefano Costanzi⁴ 

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

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

DOI  :  10.3389/fmed.2020.553075

来源: DOAJ

【 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】

Unknown