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Sustained renal response with belimumab in children with new-onset lupus nephritis
Ren Wang1, Tao Sun2, Zhuo Shi2
1Department of Pediatrics, Jinling Hospital, Nanjing Medical University, Nanjing, China.
Insights
Belimumab treatment in pediatric lupus nephritis (LN) improved kidney response and reduced flares. This biologic agent shows promise for maintaining long-term kidney function in children with LN.
Area of Science:
- Pediatric Nephrology
- Immunology
- Rheumatology
Background:
- Belimumab is approved for pediatric systemic lupus erythematosus (SLE) but requires further efficacy and safety validation in this population.
- Pediatric lupus nephritis (LN) necessitates evaluating long-term treatment impacts on renal response and disease flares.
Purpose of the Study:
- To assess belimumab's effect on sustained renal response in pediatric LN.
- To evaluate belimumab's impact on disease flare rates in children with LN.
- To inform clinical decisions regarding belimumab use in pediatric LN.
Main Methods:
- A prospective cohort study included 96 children with LN.
- Patients were divided into a belimumab group (68) and a standard treatment group (28).
- Remission rates, flare rates, and adverse events were compared between groups over 152 weeks.
Main Results:
- Belimumab increased renal response by 16.7% and complete renal response by 24.7%.
- The belimumab group experienced a 46.2% lower rate of LN flares compared to standard treatment.
- No significant difference in long-term complete remission rates was observed (P=0.081), but the standard treatment group had a higher flare rate (P=0.004).
Conclusions:
- Adding belimumab to standard treatment may preserve long-term kidney function in pediatric LN.
- Belimumab appears to be an effective and safe biologic agent for reducing LN flares.
- The findings support belimumab's role in managing pediatric lupus nephritis.
Background:
Belimumab is approved for treating systemic lupus erythematosus (SLE) in children over 5 years old; however, its efficacy and safety in pediatric SLE patients require further validation. This study aimed to evaluate the impact of belimumab on the long-term cumulative probability of sustained renal response and disease flare in children with lupus nephritis (LN), to inform clinical decision-making.
Methods:
We included a total of 96 children with LN in our study. The patients were part of a prospective cohort study and were divided into two groups: belimumab group (68 cases) and standard treatment (group (28 cases). We compared remission rates, flare rates, and adverse event incidence between these two groups.
Results:
After 152 weeks of follow-up, belimumab increased the renal response and complete renal response rates by 16.7% [odds ratios (OR) = 5.38 (1.33, 15.12)] and 24.7% [OR = 2.74 (1.04, 7.19)]. Belimumab significantly reduced the risk of LN flare, with a 46.2% lower flare rate in the belimumab group compared to the standard treatment group. There was no significant difference in long-term cumulative probability of complete remission between the belimumab and standard treatment groups (P = 0.081), and the standard treatment group had a higher flare rate (P = 0.004).
Conclusions:
Adding belimumab to standard treatment may effectively maintain long-term kidney function and reduce LN flares, making it an effective and safe biologic agent.
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