Successful treatment of refractory systemic lupus erythematosus using proteasome inhibitor bortezomib followed by belimumab: description of two cases
Successful treatment of refractory systemic lupus erythematosus using proteasome inhibitor bortezomib followed by belimumab: description of two cases
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DOI：
10.1177/0961203317691371
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发表时间：
2017-10-01
期刊：
影响因子：
2.6
通讯作者：
Eriksson, P.
中科院分区：
文献类型：
--
作者：
Sjowall, C.;Hjorth, M.;Eriksson, P.
尽管对系统性红斑狼疮（SLE）患者的假定治疗选择正在稳步增加，但难治性疾病确实是许多临床医生和患者面临的主要挑战。蛋白酶体抑制剂硼替佐米——自本世纪初被批准用于治疗多发性骨髓瘤——最近被德国同事报道成功治疗了12例难治性SLE。在本文中，我们描述了两例瑞典SLE患者的顽固性肾脏和肺部表现，他们通过硼替佐米作为缓解的诱导，然后每月剂量的贝利单抗获救。仔细监测患者的疾病活动性和肾功能。在连续的样品中分析抗dsdna和抗c1q抗体、补体蛋白和淋巴细胞亚群。2016年12月，患者在给药硼替佐米后分别处于28个月和22个月的临床缓解期。使用贝利单抗作为维持治疗，以防止再生自身反应性B细胞克隆的潜在好处进行了讨论。
Although the putative therapeutic options for patients with systemic lupus erythematosus (SLE) are steadily increasing, refractory disease is indeed a major challenge to many clinicians and patients. The proteasome inhibitor bortezomib - approved for the treatment of multiple myeloma since the beginning of this century - was recently reported successful in twelve cases of refractory SLE by German colleagues. Herein, we describe two Swedish SLE cases with refractory renal and pulmonary manifestations that were rescued by bortezomib as induction of remission followed by monthly doses of belimumab. The patients were carefully monitored with regard to disease activity and renal function. Anti-dsDNA and anti-C1q antibodies, complement proteins and lymphocyte subsets were analysed in consecutive samples. In December 2016, the patients had been in clinical remission post bortezomib administration for a period of 28 and 22 months, respectively. Potential benefits of using belimumab as maintenance therapy to prevent regeneration of autoreactive B cell clones are discussed.