Most common Biologics Used to Treat Systemic Lupus Erythematosus
| Drug | Mechanism of Action | Dose | Indication |
|---|---|---|---|
| Belimumab (Benlysta) | Monoclonal antibody that inhibits B-lymphocyte stimulator, which modulates B-cell growth and survival | 10 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 antibody | 1 g intravenous on days 1 and 15 or 375 mg/m 2 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. |
