TOPLINE

Among patients with systemic lupus erythematosus (SLE), rituximab and belimumab showed similar rates of low disease activity after adjustment. Belimumab was associated with higher drug survival than rituximab when used as second-line or later biologic therapy, but not as first-line therapy.

METHODOLOGY

• Researchers conducted a prospective, observational cohort study to compare the effectiveness of rituximab with that of belimumab in patients with SLE.
• The analysis included 176 patients with SLE who started rituximab or belimumab at a UK-based hospital between 2011 and 2025.
• Patients contributed 175 rituximab and 58 belimumab treatment courses, with a median follow-up duration of 3.4 and 2.0 years, respectively.
• The primary outcome was the attainment of low disease activity, defined as a SLE Disease Activity Index 2000 score of 4 or lower and a prednisolone dose of 5 mg/d or less.
• The researchers also assessed changes in disease activity, prednisolone dose, and kidney function, along with drug survival, analysed separately for first-line and second-line or later biologic therapy.

TAKEAWAY

• After adjustment, patients who received belimumab or rituximab showed no significant difference in achieving low disease activity. A propensity score overlap-weighted analysis also showed no difference.
• Drug survival was comparable between belimumab and rituximab when used as first-line biologic therapy.
• Among patients receiving second-line or later biologic therapy, belimumab was associated with higher drug survival than rituximab (hazard ratio, 1.34; 95% CI, 1.03-1.77).
• Disease activity and prednisolone doses declined over time with both treatments. The lupus damage index and kidney function were generally comparable.

IN PRACTICE

"[The] findings therefore do not support a general preference for either treatment," the authors of the study wrote. "Direct comparative studies are needed to better inform treatment selection in SLE," they added.

SOURCE

The study was led by Iftach Sagy, Addenbrooke's Vasculitis and Lupus Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. It was published online on October 14, 2026, in Rheumatology.

LIMITATIONS

The study was conducted at a single specialist centre, which may have limited the generalisability. Patients were not randomly assigned to receive the treatments. Adverse events were not collected systematically.

DISCLOSURES

The study did not receive any specific funding. The authors reported having no conflicts of interest.

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