Adding belimumab, an IgG monoclonal antibody that inhibits B-lymphocyte stimulator, to standard care may reduce the risk for lupus nephritis (LN) flare and slow kidney function decline, according to findings from a post hoc analysis of the BLISS-LN trial (Belimumab International Study in Lupus Nephritis; NCT01639339).
The risk for LN flare after the completion of induction therapy (week 24) was significantly reduced by 55% in the belimumab vs placebo group, Brad H. Rovin, MD, of The Ohio State University Wexner Medical Center in Columbus, Ohio, and colleagues reported in Kidney International. In a modified intention-to-treat population, belimumab therapy was significantly associated with a 48% and 53% reduced risk for a 30% decline in estimated glomerular filtration rate (eGFR) for those who remained on treatment and those who remained in the study, respectively. Belimumab therapy was significantly associated with a 62% and 65% reduced risk for a 40% decline in eGFR, respectively.
Further, the odds of a sustained 30% and 40% eGFR decline, a precursor to kidney failure, was significantly reduced by 71% and 75%, respectively, with use of the biologic. Patients treated with belimumab appeared to have gentler eGFR slopes, especially those with low baseline proteinuria, according to investigators.
These findings support conclusions of the original trial, which found that add-on belimumab was associated with favorable reductions in LN activity.
“These data demonstrate that adding belimumab to [standard care] not only facilitates control of disease activity, but also prevents LN flares and may help preserve kidney function,” Dr Rovin’s team stated. Preliminary research also suggests that belimumab may have direct anti-fibrotic effects.
In the trial, investigators randomly assigned 448 patients with class 3, 4, and/or 5 LN to intravenous belimumab or placebo in addition to standard care for 104 weeks. Standard care immunosuppression consisted of cyclophosphamide and azathioprine or mycophenolate mofetil along with glucocorticoids. Unlike in the original trial, many patients who did not experience a decrease in proteinuria to 0.7–0.8 g/d or less after 1 year of belimumab treatment still had good long-term kidney outcomes.
Disclosure: This research was supported by GlaxoSmithKline. Please see the original reference for a full list of disclosures.
Rovin BH, Furie R, Teng O, et al. A secondary analysis of the Belimumab International Study in Lupus Nephritis trial examined effects of belimumab on kidney outcomes and preservation of kidney function in patients with lupus nephritis. Kidney Int. Published online September 21, 2021. doi:10.1016/j.kint.2021.08.027