TOPLINE:

In patients with proliferative lupus nephritis, belimumab combined with standard therapy improved renal response rates, reduced glucocorticoid use over 12 months, and showed a favorable safety profile.

METHODOLOGY:

• Researchers conducted a retrospective study using data from the Spanish Belimumab Registry to evaluate the efficacy and safety of belimumab-based triple therapy for proliferative lupus nephritis.
• They included 49 patients (mean age, 37.9 years; 85.7% women) with biopsy-proven proliferative lupus nephritis who received belimumab within 6 months of a renal flare in addition to standard therapy (either mycophenolate mofetil or cyclophosphamide) with tapering glucocorticoids.
• The median time from onset of renal flare to initiation of belimumab was 1 month, and the median follow-up duration from the initiation was 24.5 months.
• The main outcomes were rates of renal response (complete, primary efficacy, and partial) at 12 months; renal response was defined by a reduction in the urine protein-to-creatinine ratio, a stable or improved estimated glomerular filtration rate (eGFR), and the absence of treatment failure or the need for rescue therapy.
• The secondary outcomes included changes in proteinuria and eGFR, glucocorticoid reduction, adverse events, and other variables. Remission and lupus low disease activity state were assessed as treat-to-target outcomes.

TAKEAWAY:

• At 12 months, 67.3% of patients achieved a complete renal response, 75.5% achieved a primary efficacy renal response, and 83.7% had at least a partial renal response; patients with baseline proteinuria levels < 3 g/d vs ≥ 3 g/d achieved significantly higher rates of complete renal response (P = .027) and primary efficacy renal response (P = .048).
• From baseline to 12 months, the mean proteinuria levels decreased from 2.7 to 0.49 g/d, the mean eGFR improved from 71.0 to 78.4 mL/min/1.73 m², and the mean prednisone dose dropped from 31.7 to 3.5 mg/d. Additionally, 26.1% of patients discontinued glucocorticoids.
• At 12 months, 40.8% of patients achieved remission, and 46.9% attained lupus low disease activity state.
• Overall, 16.3% of patients experienced renal treatment failure, and 4.1% had a renal relapse; only three adverse events were reported, including one discontinuation due to depressive symptoms. No serious adverse events were reported.

IN PRACTICE:

“These findings, consistent with both pivotal trials and Asian real-world cohorts, reinforce the robustness of [belimumab]-based triple therapy and highlight its potential to improve long-term outcomes in [lupus nephritis] when introduced early in the disease course,” the authors wrote.

SOURCE:

This study was led by Paola Vidal-Montal, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain. It was published online on January 27, 2026, in Lupus Science & Medicine.

LIMITATIONS: 

There may be heterogeneity in treatment decisions across centers. The sample size was small, and the ethnic composition may limit the generalizability of the findings. The absence of a control group prevented direct comparison with standard-of-care regimens.

DISCLOSURES:

The authors have not declared any specific grant for this study. No competing interests were declared by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.