Case Series: Belimumab in Refractory Lupus Nephritis

Abstract In recent trials for the treatment of systemic lupus erythematosus (SLE), belimumab (a recombinant human IgG1-monoclonal antibody that inhibits B lymphocyte stimulator), in addition to standard immunosuppression, has been shown to improve renal and non‐renal outcomes. We report our experience using belimumab in two cases of refractory lupus nephritis (LN), where renal remission was not achieved using cyclophosphamide, mycophenolate mofetil and other immunosuppressive medications. In one of the cases, belimumab therapy led to a partial remission of LN, improvement in serological markers of SLE and disease activity, which permitted a reduction in prednisolone dosing. Treatment with efficacious therapies early in the course of LN is a desirable therapeutic strategy, to achieve early remission of proteinuria and curtail the development of irreversible chronic renal damage. Further studies are needed to provide information on the effectiveness of belimumab for maintenance of remission, prevention of flares and monitoring for long term complications of B cell modulation.