Successful treatment of refractory systemic lupus erythematosus using proteasome inhibitor bortezomib followed by belimumab: description of two cases.
Although the putative therapeutic options for patients with systemic lupus erythematosus (SLE) are steadily increasing, refractory disease is indeed a major challenge to many clinicians and patients. The proteasome inhibitor bortezomib - approved for the treatment of multiple myeloma since the beginning of this century - was recently reported successful in twelve cases of refractory SLE by German colleagues. Herein, we describe two Swedish SLE cases with refractory renal and pulmonary manifestations that were rescued by bortezomib as induction of remission followed by monthly doses of belimumab. The patients were carefully monitored with regard to disease activity and renal function. Anti-dsDNA and anti-C1q antibodies, complement proteins and lymphocyte subsets were analysed in consecutive samples. In December 2016, the patients had been in clinical remission post bortezomib administration for a period of 28 and 22 months, respectively. Potential benefits of using belimumab as maintenance therapy to prevent regeneration of autoreactive B cell clones are discussed.
1 Rheumatology/AIR, Department of Clinical and Experimental Medicine, Linköping University, Sweden.
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C
Sjöwall
2 Clinical Immunology & Transfusion Medicine, Department of Clinical and Experimental Medicine, Linköping University, Sweden.
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M
Hjorth
1 Rheumatology/AIR, Department of Clinical and Experimental Medicine, Linköping University, Sweden.
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P
Eriksson
D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000627:therapeutic use*; D000069286:Bortezomib / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy* / Q000503:physiopathology; D008875:Middle Aged; D061988:Proteasome Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D013548:Sweden; D016896:Treatment Outcome
D061067:Antibodies, Monoclonal, Humanized; D007166:Immunosuppressive Agents; D061988:Proteasome Inhibitors; D000069286:Bortezomib; C511911:belimumab
Anti-DNA antibodies; renal lupus; systemic lupus erythematosus