Benlysta For Lupus
By Dr. Landis
October 2018
Lupus was first characterized in the 1800’s. It started with the identification of discoid lupus and followed with the observations that lupus would also cause damage to the internal organs. It was also noted to have times of severe activity followed by remission.
Research in the 1920s and 1930s led to the first pathologic descriptions of lupus and demonstrated how the disease affected the kidney, heart, and lung. In 1948, researchers at the Mayo Clinic discovered that the white blood cells in lupus patients were digesting other cells. The digested cell was coated with antibodies called the anti-nuclear antibody (ANA). The ANA was found not only in lupus patients, but also in patients with other autoimmune diseases, as well as normal healthy individuals.
In order to ensure a more accurate diagnosis when testing a patient for lupus, the American College of Rheumatology established a list of clinical and immunologic criteria that point to lupus. The criteria were made for the purpose of identifying people for clinical studies. A person has SLE if any 4 out of the following 11 symptoms are present simultaneously or serially on two separate occasions.
Malar rash
Discoid rash
Serositis: Inflammation around heart or lungs or abdomen
Oral ulcers: includes oral or nasopharyngeal ulcers
Arthritis
Photosensitivity
Low platelets or low red blood cells (due to destruction) or low white blood cells
Kidney disorder
Positive ANA
Positive anti-Smith, anti-ds DNA, antiphospholipid antibody, or false positive syphilis test
Neurologic disorder
Treatments for lupus started in the 1800’s with quinine and salicylates. In the mid 1900’s, steroids were used for treatment. In 1955, the FDA approved hydroxychloroquine for the treatment of lupus, and it is still the initial treatment for lupus today. Since then, other immunosuppressants have been used off-label in the treatment of lupus including, but not limited to, Cytoxan, CellCept, methotrexate, and Imuran. In 2010, the FDA approved the use of Benlysta for lupus.
Benlysta is a human monoclonal antibody that inhibits B-cell activating factor (BAFF). In lupus patients, BAFF is overexpressed. Researchers think that BAFF overexpression causes autoimmune B-cell proliferation and survival, which leads to lupus. Without the survival factor BAFF, B-cells commit suicide and no longer contribute to the autoimmune damage of lupus.
In the Benlysta trials, there was a mild improvement in symptoms when compared to placebo. The areas of improvement were notable in the joints and skin. Benlysta allowed patients to significantly reduce their use of corticosteroids. During the trials, Benlysta was not used in severe forms of lupus such as lupus nephritis or cerebritis.
Benlysta infusions take about 1 hour to complete. Side effects can include, but are not limited to, GI upset, increased risk for infection, depression, infusion reactions, low white blood counts and headache.