Effectiveness of Belimumab for Glucocorticoid Discontinuation in Juvenile-onset Lupus Nephritis

Lupus nephritis (LN) is an important complication of systemic lupus erythematosus, for which glucocorticoids (GCs) are the primary treatment. Due to the side effects associated with GCs, their long-term use should ideally be tapered and discontinued. At present, no such possibility exists without problematic flares after discontinuation. We administered belimumab, a human monoclonal antibody that binds to a soluble B lymphocyte stimulator to reduce the number of activated B cells, to six patients with Type IV LN to discontinue GCs. The six patients were 10-15 years old when LN developed and 15-24 years old when belimumab treatment was initiated. Prednisolone was tapered from 6 to 20 mg by 2.5-5 mg every month until the dosage reached 5 mg, at which point the dosage was further reduced by 1 mg every 6 months. One patient was transferred to another hospital midway and five patients discontinued GCs. No flares occurred 8-38 months post discontinuation. No adverse effects were observed following belimumab treatment. In conclusion, belimumab was effective in the successful discontinuation of GCs.