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Indication and Use
Patients aged 5+ with active systemic lupus erythematosus (SLE) or lupus nephritis, receiving standard therapy.
Mechanism of Action
Target: Belimumab is a monoclonal antibody that inhibits B lymphocyte stimulator protein (BLyS), reducing the survival of B cells, including autoreactive B cells, and decreasing the differentiation of B cells into immunoglobulin-producing plasma cells.
Administration and Dosing
Intravenous (IV):
Initial: 10 mg/kg every 2 weeks for the first 3 doses. Maintenance: 10 mg/kg every 4 weeks.
Subcutaneous (SubQ):
Initial: 400 mg once weekly for 4 doses. Maintenance: 200 mg once weekly.
Transitioning from IV to SubQ: Administer the first SubQ dose 1 to 2 weeks after the last IV dose.
Safety and Monitoring
Hypersensitivity Reactions
Infections
Psychiatric Events: Depression, anxiety, and suicidal ideation have been observed. Assess psychiatric status before and during treatment.
Progressive Multifocal Leukoencephalopathy (PML): Rare but serious. Interrupt treatment if PML is suspected.
Adverse Reactions
Common (>10%): Nausea (15%), diarrhea (12%), infections (serious infection 6%), hypersensitivity reactions (13%).
Serious (≤1%): Suicidal ideation, severe infections, anaphylaxis, PML.
Fun Fact :Belimumab is unique in targeting BLyS, a protein crucial for B cell survival, making it a novel approach in managing autoimmune conditions like SLE and lupus nephritis.
Key Considerations
No dosage adjustments are necessary for renal or hepatic impairment.
Live vaccines: Avoid live vaccines 30 days before and during belimumab therapy due to increased risk of infection.
Black Patients: Some studies suggest reduced response rates in Black patients, indicating a need for personalized treatment considerations.
Self-Administration: self-administer SubQ injections.