Biological disease-modifying antirheumatic drugs (bDMARDs) for SLE
The role of biological disease-modifying antirheumatic drugs (bDMARDs) in SLE is unclear. B cell–modulating therapies (eg rituximab, belimumab) are most commonly used; other biological drugs (eg tumour necrosis factor [TNF] inhibitors) have not been shown to be useful.
Rituximab is a specific bDMARD (B-cell antigen CD20 inhibitor) that may be used in patients with severe, refractory SLE. It may be indicated for kidney disease, haematological disease or neuropsychiatric diseaseFanouriakis, 2019.
Studies of rituximab that assessed diverse clinical outcomes in heterogeneous SLE patient populations did not show a benefitRamos-Casals, 2009, but rituximab may have a role in certain patient subgroups (eg refractory lupus nephritis). If rituximab is indicated as part of combination therapy for SLE in adults, use:
rituximab 1 g intravenously, as a single dose; repeat dose after 2 weeks. rituximab rituximab rituximab
For additional considerations specific to rituximab use, see Specific considerations for use of biological or targeted-synthetic disease-modifying antirheumatic drugs (b/tsDMARDs).
Belimumab1 is a specific bDMARD (targeting B-cell activating factor) that has been shown to be beneficial as an add-on therapy in severe active SLE to reduce disease activitySingh, 2021. If belimumab is indicated as part of combination therapy for SLE in adults, use:
belimumab 10 mg/kg intravenously, as a single dose at 0, 2 and 4 weeks, and thereafter every 4 weeks. belimumab belimumab belimumab
For additional considerations specific to belimumab use, see Specific considerations for use of biological or targeted-synthetic disease-modifying antirheumatic drugs (b/tsDMARDs).