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Management of Systemic Lupus Erythematosus

           i)  Belimumab
           Belimumab  is  a  recombinant,  fully  human  monoclonal  antibody  that
           inhibits  the  biologic  activity  of  B-lymphocyte  stimulator  (BLyS),  also
           known as B-cell activating factor (BAFF). This agent is indicated as an
           adjunct therapy in patients with active SLE who are receiving standard
           therapy and for the treatment of LN. 71, level III
           In a Cochrane systematic review of six RCTs on SLE, belimumab was
           more effective than placebo in terms of: 72, level I
             •  reduction of at least 4-point in SELENA-SLEDAI score (RR=1.33,
               95% CI 1.22 to 1.45)
             •  improvement in quality of life based on 36-item short-form (SF-36)
               (MD=1.60, 95% CI 0.30 to 2.90)
             •  reduction in corticosteroids dose by at least 50% (RR=1.59, 95%
               CI 1.17 to 2.15)

           In another systematic review of 12 studies which included seven RCTs,
           belimumab was more effective than placebo in SLE patients based on
           SLE Responder Index (SRI). 73, level I

           Belimumab was reported to have a good safety profile. 72 - 73, level I

           ii)  Anifrolumab
           Anifrolumab  is  a  human  monoclonal  antibody  to  type  I  interferon
           receptor subunit 1. It is a newly approved adjunct therapy for patients
           with moderate to severe SLE.

           In  a  landmark  RCT  among  patients  with  moderate  to  severe  SLE
           (Treatment of Uncontrolled Lupus via the Interferon Pathway [TULIP]-2),
           anifrolumab was more effective than placebo in terms of: 74, level I
             •  higher  percentage  of  British  Isles  Lupus  Assessment  Group-
               based Composite Lupus Assessment (BICLA) responder at week
               52 (difference=16.3%, 95% CI 6.3 to 26.3)
             •  reduction of corticosteroids dose (difference=21.2%, 95% CI 6.8
               to 35.7)
             •  reduction of CLASI by ≥50% at week 12 (difference=24.0%, 95%
               CI 4.3 to 43.6)
           The most frequent AEs among patients on anifrolumab reported in this
           trial  were  upper  respiratory  tract  infection,  nasopharyngitis,  infusion-
           related reaction, bronchitis and herpes zoster.
           iii)  Rituximab
           Rituximab  is  a  chimeric  anti-CD20  antibody  that  induces  peripheral
           B-cells depletion.





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