Department of Autoimmune Diseases, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Hospital Clinic, Barcelona, Catalonia, Spain.
Department of Internal Medicine, Centro Hospitalar Tâmega e Sousa, Guilhufe-Porto, Portugal.
Lupus. 2021 Jan;30(1):134-140. doi: 10.1177/0961203320965707. Epub 2020 Oct 20.
Systemic lupus erythematosus (SLE) is an autoimmune condition with a wide spectrum of clinical manifestations encompassing most organs and systems. Its treatment approach includes different immunomodulatory treatments, of which B-cell targeted therapies are part of. Rituximab (an anti-CD20 antibody) had encouraging results in observational studies but failed when tested in clinical trials. It is theorized that this could have been partially due to BAFF upregulation, leading to rituximab failure. Therefore, targeting BAFF with belimumab after rituximab therapy, may have a synergic effect in SLE. We review the available observational data regarding sequential rituximab/belimumab therapy in SLE patients. Twenty-four patients from 6 studies were included. The results suggest a benefit with this combined therapy, with reduction of the mean SLEDAI. However, there was significant drug regimen and patient selection heterogeneity. Further randomized clinical trials are needed to examine this drug sequencing protocol in SLE patients.
系统性红斑狼疮 (SLE) 是一种自身免疫性疾病，具有广泛的临床表现，涵盖了大多数器官和系统。其治疗方法包括不同的免疫调节治疗，其中 B 细胞靶向治疗是其中的一部分。利妥昔单抗（一种抗 CD20 抗体）在观察性研究中取得了令人鼓舞的结果，但在临床试验中却失败了。据推测，这可能部分归因于 BAFF 的上调，导致利妥昔单抗治疗失败。因此，在用利妥昔单抗治疗后用贝利尤单抗靶向 BAFF，可能在 SLE 中具有协同作用。我们回顾了 SLE 患者接受序贯利妥昔单抗/贝利尤单抗治疗的现有观察性数据。纳入了来自 6 项研究的 24 名患者。结果表明，这种联合治疗有获益，SLEDAI 均值降低。然而，药物方案和患者选择存在显著异质性。需要进一步的随机临床试验来研究 SLE 患者的这种药物序贯方案。
