Clinical efficacy of belimumab in patients with systemic lupus erythematosus and headache. A report of two cases

Kodera, Takao; Tsutsumi, Tomomi; Oka, Yasu; Takeda, Tomoki; Shirota, Yuko; Kameoka, Junichi

doi:10.1093/mrcr/rxab003

Cited by 4 publications

(4 citation statements)

References 17 publications

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“…The literature describing the effects of belimumab in patients with refractory NPSLE remains scarce 7–9 . While the results of further prospective clinical trials are eagerly awaited, a post hoc analysis of the available phase 3 trials of lupus patients with a headache at baseline concluded in favor of belimumab 10 ; two further studies and our case are consistent with this finding 7,8 . Additionally, MRI findings stabilized over time.…”

Section: Discussionsupporting

confidence: 78%

“…Belimumab, a monoclonal antibody against B‐cell activating factor (BAFF), is the first specific drug approved for the treatment of both SLE 4,5 and LN 6 . The literature describing the effects of belimumab in patients with refractory NPSLE remains scarce 7–9 . While the results of further prospective clinical trials are eagerly awaited, a post hoc analysis of the available phase 3 trials of lupus patients with a headache at baseline concluded in favor of belimumab 10 ; two further studies and our case are consistent with this finding 7,8 .…”

Section: Discussionsupporting

confidence: 76%

“…[7][8][9] While the results of further prospective clinical trials are eagerly awaited, a post hoc analysis of the available phase 3 trials of lupus patients with a headache at baseline concluded in favor of belimumab 10 ; two further studies and our case are consistent with this finding. 7,8 Additionally, MRI findings stabilized over time. Elevated levels of BAFF in patients with NPSLE may be locally produced by astrocytes or immigrant immune cells, or it could derive from systemic cytokine production degrading the blood-brain barrier via an invasion of autoantibodies into the brain, then progressing to tissue damage.…”

Section: Discussionsupporting

confidence: 73%

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Belimumab shows promise in neuropsychiatric lupus: Another challenge to find the offender

Hou

Liu

et al. 2023

Rheumatology & Autoimmunity

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Introduction: Agents that can be used for the treatment of neuropsychiatric lupus (NPSLE) are lacking in the therapeutic armamentarium. Belimumab is a monoclonal antibody targeting the B-cell activating factor (BAFF) and is approved by the US Food and Drug Administration as an additional treatment for systemic lupus erythematosus patients with persistent disease activity and lupus nephritis (LN); however, severe active central nervous system manifestations were excluded. Case Report: We report on a treatment-naïve LN patient with refractory NPSLE complicated with progressive posterior reversible encephalopathy syndrome (PRES) who was successfully treated via the combination of mycophenolate and belimumab, resulting in reversal of persistent headache and neuroradiologic manifestations. Conclusion: Research on this topic could be relevant for identifying a possible correlation between BAFF and psychiatric NPSLE manifestations. K E Y W O R D S belimumab, lupus nephritis, neuropsychiatric lupus, posterior reversible encephalopathy syndrome Key points• The nephrotic state is a specific risk factor for posterior reversible encephalopathy syndrome (PRES) in patients with lupus renal flares. • Belimumab showed efficacy and safety in a lupus nephritis patient with PRES.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionsupporting

confidence: 76%

Section: Discussionsupporting

confidence: 73%

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Belimumab shows promise in neuropsychiatric lupus: Another challenge to find the offender

Hou

Liu

et al. 2023

Rheumatology & Autoimmunity

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“…Recently, two cases of headache were reported with a refractory migraine pattern to triptans that improved after the use of belimumab, a monoclonal antibody that neutralizes the B lymphocyte stimulator. 107 A post hoc analysis of BLISS-52 and BLISS-76 studies that included 1684 patients with SLE, identified 24 (1.4%) with lupus headache. The reported improvement rate was 20%, 100%, and 69.2% with the use of placebo, belimumab 1, and 10 mg/kg, respectively.…”

Section: Lupus Headachementioning

confidence: 99%

Headache and systemic lupus erythematosus: A narrative review

Oliveira

Rocha-Filho

2023

Headache

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Objective To review the epidemiology, the differential diagnosis, and the clinical and laboratory factors associated with the care management of headaches in patients with systemic lupus erythematosus (SLE). Background SLE is a chronic autoimmune disease and in 12%–95% of patients, the nervous system is involved. Headache is a frequently reported, although nonspecific, symptom that may potentially represent serious underlying diagnoses. Primary headaches may also occur in these patients, thereby causing a negative and significant impact on their quality of life. Methods This is a narrative review. A literature review was conducted on the PubMed platform using the following terms: (1) headache and (2) lupus. All articles considered relevant were included. No limitations were imposed for the publication date. Results Headache is a frequent symptom in patients with SLE. Although its prevalence is similar to the general population, headaches nonetheless tend to have a greater negative impact on these patients. Patients with SLE are more likely to experience headache due to vascular diseases such as cerebral venous sinus thrombosis, stroke, reversible cerebral vasoconstriction syndrome, posterior reversible encephalopathy syndrome, and vasculitis. Aseptic meningitis, neuroinfections, intracranial neoplasms, and intracranial hypertension or hypotension may also be a cause of headache in these patients. Although used in disease activity scores, the concept of lupus headache is controversial. Conclusions Headache is a frequent symptom in patients with SLE. An appropriate approach enables the potentially serious conditions, which are the causes of secondary headaches, to be recognized and treated, together with an appropriate diagnosis and treatment of primary headaches.

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Diagnosis and Management of Pediatric Neuropsychiatric Systemic Lupus Erythematosus: An Update

Unal,

Cam,

Emreol

et al. 2024

Pediatr Drugs

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Clinical efficacy of belimumab in patients with systemic lupus erythematosus and headache. A report of two cases

Cited by 4 publications

References 17 publications

Belimumab shows promise in neuropsychiatric lupus: Another challenge to find the offender

Belimumab shows promise in neuropsychiatric lupus: Another challenge to find the offender

Headache and systemic lupus erythematosus: A narrative review

Diagnosis and Management of Pediatric Neuropsychiatric Systemic Lupus Erythematosus: An Update

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