DUAL THERAPY WITH BIOLOGICALS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Objective: to determine the efficiency of dual anti-B cell therapy in patients with active systemic lupus erythematosus (SLE).

Subjects and methods. The clinic of the V.A. Nasonova Research Institute of Rheumatology followed up three patients with significant SLE, who took rituximab (RTM) at a dose of 500–1000 mg, three months after completion of RTM infusions they received belimumab (BLM) calculated with reference to 10 mg/kg once monthly, a total of 8 infusions. The follow-up lasted 1 year. The efficiency and tolerability of the therapy and the concentrations of autoantibodies, complement, and B-lymphocyte subpopulations were estimated at baseline and then every 3 months.

Results and discussion. During dual anti-B cell therapy, there was considerable clinical improvement, no signs of recurrent SLE throughout the follow-up period, as well as normalization of laboratory markers for disease activity (the concentrations of antibodies against native DNA and complement components C3 and CD4) and persistent depletion of autoreactive B lymphocytes, plasma cells in particular. In all patients, the dose of glucocorticoids (GC) could be decreased to 7.5 mg/day calculated with reference to prednisolone at 2 months after the therapy was completed.

Conclusion. Dual anti-B cell therapy is a novel promising treatment for active SLE. This treatment regimen contributes to rapid suppression of disease activity, to long-term persistence of the obtained effect, and to reduced risk of severe irreversible organ damages, by minimizing the dose of GCs.

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