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CASE REPORT article
Front. Immunol.
Sec. B Cell Biology
Volume 15 - 2024 |
doi: 10.3389/fimmu.2024.1459241
Successful Management of Belimumab After Obinutuzumab in a Patient with Systemic Lupus Erythematosus: A Case Report with an 18-month Follow-up
Provisionally accepted- Second Hospital of Jiaxing City, Jiaxing, China
Systemic lupus erythematosus (SLE) is a complex autoimmune disease, and despite the availability of multiple treatments, striking a balance between long-term efficacy and side effects remains a major clinical challenge. B-cell-directed therapy has attracted much attention because of its unique mechanism of action. Belimumab and obinutuzumab, as representative drugs for B-cell-directed therapy, have shown their respective advantages for SLE treatment. However, data on combination therapy with obinutuzumab and belimumab are currently unavailable.We present the severe case report of a patient who was diagnosed with lupus nephritis (LN) with gastrointestinal involvement and developed acute renal failure. The patient responded to the first dose of obinutuzumab but failed to achieve a complete response to LN. The repeated use of obinutuzumab was limited by persistently low IgG levels and frequent infections. This is a real-world challenge that must be addressed. Therefore, the patient was subsequently treated with a novel sequential regimen of obinutuzumab followed by belimumab. After 18 months of follow-up, the patient achieved a complete clinical response with a favourable safety profile, along with the conversion of all autoantibodies from positive to negative and sustained negativity. To date, the patient has achieved a dual clinical and serological response.There is reason to believe that this novel combination regimen could be developed as a therapeutic strategy, with the expectation of balancing efficacy and safety.
Keywords: systemic lupus erythematosus, Lupus Nephritis, Gastrointestinal involvement, Obinutuzumab, belimumab
Received: 03 Jul 2024; Accepted: 09 Sep 2024.
Copyright: © 2024 Pu, Ye, Zhu and YAN. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
TINGTING YAN, Second Hospital of Jiaxing City, Jiaxing, China
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