Most common Biologics Used to Treat SLE

Most common Biologics Used to Treat Systemic Lupus Erythematosus

DrugMechanism of ActionDoseIndication
Belimumab (Benlysta)Monoclonal antibody that inhibits B-lymphocyte stimulator, which modulates B-cell growth and survival10 mg/kg intravenous monthly
200 mg subcutaneous weekly
• Has been used as an “add on” for patients who have not fully responded to other therapies.• Consider for musculoskeletal or mucocutaneous manifestations; notably patients with renal disease and severe active central nervous system disease were excluded from the trials• Patients are more likely to respond if they are serologically active (+dsDNA, low complements).• Cytopenias less likely to respond• Watch for depression (black box warning)• B cells decrease by 50% on this drug
Rituximab (Rituxan)anti-CD 20 monoclonal antibody1 g intravenous on days 1 and 15 or 375 mg/m weekly × 4 doses• Randomized trials did not show statistically significant benefit.• Open label study has shown benefit in recalcitrant disease• Used in catastrophic antiphospholipid antibody syndrome• Has been combined with cyclophosphamide (15 mg/kg) on days 1 and 15) for its immunomodulating effects in addition to B cell depletion.
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