Efficacy of belimumab on extra-renal lupus in patients with lupus nephritis and end-stage renal disease

Background: Lupus nephritis (LN) is a severe complication of systemic lupus erythematosus (SLE), with approximately 20-30% of LN patients progressing to end-stage renal disease (ESRD) within a decade. Persistent extra-renal SLE activity, cardiovascular events, and infections significantly contribute to adverse outcomes. Current therapeutic strategies primarily rely on glucocorticoids and immunosuppressants; however, the adverse effects of these agents are intensified in ESRD patients. Belimumab, a B-lymphocyte-targeted biologic agent, has demonstrated efficacy in managing SLE but lacks sufficient data regarding its application in ESRD-LN patients. This study aims to evaluate the role of belimumab in controlling extra-renal disease activity, optimizing medication use, and assessing safety in ESRD-LN patients. Methods: or on hemodialysis) who received belimumab treatment. Data on SLE manifestations, medications, and laboratory parameters were collected before and after ESRD onset. The primary endpoints included changes in extra-renal Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores, adjustments in prednisone dosages, and the incidence of infection episodes during belimumab therapy. Results: < 0.01) and improved complement C3 levels (from 0.64 ± 0.12 g/L to 0.8 ± 0.16 g/L). Glucocorticoid dosages were markedly reduced (from 21.25 ± 9.64 mg/day to 3.91 ± 3.98 mg/day), with three patients discontinuing glucocorticoid therapy entirely. Mild infections were observed, but no severe infections requiring mechanical ventilation were reported. Conclusion: Belimumab appears to be a promising therapeutic option for ESRD-LN patients, effectively controlling extra-renal disease activity, reducing glucocorticoid use, and demonstrating a favorable safety profile. Further research is required to optimize dosing strategies and to validate the long-term efficacy and safety of belimumab in this high-risk population.