Roger A Levy, MD, PhD: KDIGO Guidelines Recommend Belimumab for Lupus Nephritis

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Roger A Levy, MD, PhD, discusses the recent guideline updates regarding the treatment and management of lupus nephritis.

In 2020, the BLISS-LN study published in the New England Journal of Medicine evaluated belimumab (Benlysta) in addition to standard care versus standard care alone for the treatment of lupus nephritis. The results revealed patients receiving belimumab alongside standard therapy exhibited faster and more frequent improvement in inflammation. Moreover, they were less likely to progress to end-stage kidney disease, marking a significant advancement.

Based on this evidence, the Kidney Disease: Improving Global Outcomes (KDIGO), a group of international nephrology experts, updated their guidelines in January 2024. They now recommend early use of belimumab in the treatment of lupus nephritis, particularly for patients with class III or IV. This recommendation aligns with the study data, indicating a reduced likelihood of relapses and improved preservation of kidney function when initiating belimumab early in the treatment process.

In an interview with HCPLive, Roger A Levy, MD, PhD, senior global medical director at GSK Specialty Medicine, discussed the recent guideline updates regarding the treatment and management of this condition.

Lupus nephritis, a condition affecting around 50 — 60% of all lupus patients, usually develops within the first 5 years after the initial lupus diagnosis. However, some individuals may experience lupus nephritis as their first symptom, making diagnosis challenging.

Therefore, early detection is essential, as delayed biopsy results may lead to irreversible scarring, influencing the decision on whether to initiate treatment. Despite the lack of pronounced symptoms, such as leg edema or high blood pressure, lupus nephritis can be identified through signs like blood in the urine or increased protein levels. Swift biopsy and treatment are critical for better outcomes.

“With [these updates], they are showing their support of the data that was found in the study that demonstrate that, if you add this treatment in the initial phase, you are less likely to have relapses, meaning new flares of the inflammation in the kidney,” Levy explained. “You are [also] more likely to preserve the kidney function, [therefore] protecting the kidney from the damage caused by this dreadful disease.”