[Recommendation for use of belimumab for systemic lupus erythematosus]

The central role of B-lymphocytes in the pathogenesis of systemic lupus erythematosus (SLE) has turned the attention particularly to more specific B-cell targeted therapies in recent years. Belimumab is a monoclonal antibody against the B-lymphocyte stimulator BlyS and was approved in 2011 as additional therapy for adult patients with SLE. Based upon the available data, treatment with belimumab is recommended in patients with clinically and serologically active SLE despite individually adjusted standard therapy. The standard therapy usually consists of antimalarial agents, an immunosuppressive drug (e.g. azathioprine) and/or steroids. Even the necessity for regular higher dosages of ≥ 7.5 mg prednisolone equivalents/day could be a feasible medical indication for belimumab. Due to lacking data the use of belimumab is not recommended for the purpose of treating severe active SLE with renal or central nervous system involvement until efficacy has been shown for these indications.