Department of Nephrology, Monash Health, Melbourne, Victoria, Australia.
Department of Pathology, Monash Health, Melbourne, Victoria, Australia.
Intern Med J. 2023 Oct;53(10):1901-1906. doi: 10.1111/imj.16242.
In recent trials for the treatment of systemic lupus erythematosus (SLE), belimumab (BLM), in addition to standard immunosuppression, has been shown to improve renal and nonrenal outcomes. We report our experience using BLM in three cases of refractory lupus nephritis (LN), where renal remission was not achieved using cyclophosphamide, mycophenolate mofetil and other immunosuppressive medications. In two of the three cases, BLM 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 BLM for maintenance of remission, prevention of flares and monitoring for long-term complications of B-cell modulation.
在最近针对系统性红斑狼疮 (SLE) 的治疗试验中，除了标准的免疫抑制治疗外，贝鲁单抗 (BLM) 已被证明可以改善肾脏和非肾脏结局。我们报告了在三例难治性狼疮肾炎 (LN) 患者中使用 BLM 的经验，在这些患者中，环磷酰胺、霉酚酸酯和其他免疫抑制药物未能使肾脏缓解。在这三例中的两例中，BLM 治疗导致 LN 部分缓解，SLE 的血清学标志物和疾病活动改善，从而允许减少泼尼松龙的剂量。在 LN 病程早期使用有效的治疗方法是一种理想的治疗策略，以实现蛋白尿的早期缓解，并遏制不可逆的慢性肾损伤的发展。需要进一步的研究来提供关于 BLM 维持缓解、预防发作和监测 B 细胞调节的长期并发症的有效性信息。
