Belimumab in Lupus Nephritis: A Systematic Review and Meta-Analysis

Abstract

Belimumab is a recombinant human IgG-1λ monoclonal antibody. It inhibits the B-cell activating factor (BAFF) and is approved for patients with systemic lupus erythematosus (SLE) older than five years with positive autoantibody. We aimed to evaluate the role of belimumab in the maintenance phase of treatment for lupus nephritis (LN). PubMed, PubMed Central (PMC), Cochrane Library, and Embase were searched using appropriate keywords. The screening of title and abstract was done in Covidence, followed by data extraction of the relevant studies based on inclusion criteria. Review manager (RevMan 5.4) was used for data analysis with random or fixed effects model based on heterogeneities. Two randomized controlled trials were included in the quantitative analysis. There were 1.71 times higher odds of complete renal response in the belimumab group than in the control group (odds ratio (OR), 1.71; 95% confidence interval (CI), 1.12-2.60; I-square (I 2 ) ​​​​= 0%). Similarly, there was 34% lower odds for having no response among the belimumab group (OR, 0.66; 95% CI, 0.45-0.96; I 2 = 0%). No significant differences between the two groups were observed for the occurrence of treatment-related adverse events (TRAEs) (OR, 1.07; 95% CI, 0.74-1.56; I 2 = 0%), treatment-related serious adverse events (OR, 0.54; 95% CI, 0.15-1.96; I 2 = 68%), and treatment-related infections (OR, 0.65; 95% CI, 0.27-1.55; I 2 = 21%).Therefore, belimumab and standard treatment were instrumental for beneficial renal response in patients with lupus nephritis and were not associated with increased odds of adverse effect compared with the standard treatment alone.

Effectiveness and safety of Belimumab combined with standard therapy in severe active lupus nephritis requiring kidney replacement therapy: A case report and literature review

“…Meta-analysis showed that the probability of the Belimumab trial group achieving a CRR was 1.71 times that of the control group. There were no significant differences in the incidence of treatment-related AEs and serious AEs between the two groups (13). In terms of the efficacy and safety of Belimumab in treating LN, the U.S. Food & Drug Administration (FDA) approved Belimumab to treat adults with active LN who are receiving standard therapy in December 2020 (14).…”

Developing high-affinity decoy receptors to treat multiple myeloma and diffuse large B cell lymphoma

“…However, the multifaceted ligand/receptor interactions between APRIL and BAFF and their receptors BCMA, BAFF-R, and TACI are particularly challenging to overcome. Past strategies have used ligand neutralization approaches with monoclonal antibodies or decoy receptors for BCMA, BAFF-R, and TACI in a limited number of disease applications ( Rossi et al, 2009 ; Shrestha et al, 2021 ; Tai and Anderson, 2019 ). We hypothesized that a soluble BCMA decoy receptor with endogenous, strong affinity to APRIL can successfully target APRIL-driven MM tumors despite the heterogenous cytogenetic profile of MM.…”

Health-related quality of life, fatigue and health utilities in lupus nephritis: A systematic literature review

“…3,5 Despite this, SLRs reporting the impact of LN on HRQoL, fatigue, and health utilities are limited. Although some SLRs have focused on the management and economic burden of LN, [44][45][46][47] there is a need for more SLRs that are focused on the humanistic burden. Therefore, this SLR was carried out to assess the impact of LN on HRQoL, fatigue, and health utilities in this specific subpopulation of patients with SLE.…”