Efficacy of Belimumab for refractory systemic lupus erythematosus (SLE) involving the central nervous system

Neuropsychiatric manifestations of SLE (NPSLE) is associated with increased morbidity and mortality, intractable, complicating, and poor prognosis [ 1 Magro-Checa C Zirkzee EJ Huizinga TW Steup-Beekman GM. Management of neuropsychiatric systemic lupus erythematosus: current approaches and future perspectives. Drugs. 2016; 76: 459-483 Crossref PubMed Scopus (86) Google Scholar , 2 Bertsias GK Boumpas DT. Pathogenesis, diagnosis and management of neuropsychiatric SLE manifestations. Nat Rev Rheumatol. 2010; 6: 358-367 Crossref PubMed Scopus (172) Google Scholar , 3 Kampylafka EI Alexopoulos H Kosmidis ML Panagiotakos DB Vlachoyiannopoulos PG Dalakas MC et al. Incidence and prevalence of major central nervous system involvement in systemic lupus erythematosus: a 3-year prospective study of 370 patients. Plos One. 2013; 8: e55843 Crossref PubMed Scopus (60) Google Scholar ]. Although the severity of NPSLE correlates with poor prognosis, no established treatment protocol and resistance to general treatment in many cases are making this condition worse. Existing studies has shown expression of key B cell cytokines such as BAFF and IL-6 were increased in SLE [ [4] Aringer M Costenbader K Daikh D et al. European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Ann Rheum Dis. 2019; 78: 1151-1159 Crossref PubMed Scopus (318) Google Scholar , [5] Iaccarino L Andreoli L Bocci EB et al. Clinical predictors of response and discontinuation of Belimumab in patients with systemic lupus erythematosus in real life setting. Results of a large, multicentric, nationwide study. J Autoimmun. 2018; 86: 1-8 Crossref PubMed Scopus (57) Google Scholar ]. Belimumab, an anti-BAFF monoclonal antibody, was approved by the FDA for use in treating SLE. Belimumab has recently been used for the treatment of a variety of SLE disease conditions [ [4] Aringer M Costenbader K Daikh D et al. European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Ann Rheum Dis. 2019; 78: 1151-1159 Crossref PubMed Scopus (318) Google Scholar ]. To date, reports on Belimumab treatment for SLE have covered various conditions, resulting in a decrease in the SLE DAI score, arthropathy, nephropathy, thrombocytopenia and hemolytic anemia, while the effect of Belimumab on refractory NPSLE is still unclear [ [6] George-Chandy A Trysberg E Eriksson K. Raised intrathecal levels of APRIL and BAFF in patients with systemic lupus erythematosus: relationship to neuropsychiatric symptoms. Arthritis Res Ther. 2008; 10: R97 Crossref PubMed Scopus (71) Google Scholar , [7] Hopia L Thangarajh M Khademi M Laveskog A Wallström E Svenungsson E Andersson M. Cerebrospinal fluid levels of a proliferation-inducing ligand (APRIL) are increased in patients with neuropsychiatric systemic lupus erythematosus. Scand J Rheumatol. 2011; 40: 363-372 Crossref PubMed Scopus (17) Google Scholar ].