Article Text

AB0520 Evaluating the Effect of Belimumab on Clinical Disease Activity and B-Cell in Patients with Systemic Lupus Erythematosus
  1. D. Hernandez-Flόrez,
  2. L. Valor,
  3. T. del Río,
  4. J.C. Nieto,
  5. J. Martinez,
  6. J. Ovalles,
  7. C. Gonzalez,
  8. F.J. Lόpez-Longo,
  9. I. Monteagudo,
  10. E. Naredo,
  11. L. Carreño
  1. Rheumatology, Hospital General Universitario Gregorio Marañόn, Madrid, Spain


Background Systemic lupus erythematosus (SLE) is an autoimmune inflammatory disease with wide ranging multi-systemic effects and clinical manifestations of fluctuating intensity and severity (1). This is characterized by dysfunction of T-cells and B-cell (BC) activation and an abnormal production of autoantibodies (2). Anomalous patterns in the expression of pro-inflammatory and anti-inflammatory cytokines and soluble proteins concentration such as sBAFF (B- soluble cell activating factor) has been described. Belimumab is a fully humanised monoclonal antibody against BAFF for use in combination with standard immunosuppressants in autoantibody-positive SLE (3).

Objectives To evaluate the impact of belimumab on disease activity, serological and phenotypical B-cell markers in SLE patients.

Methods Eight patients diagnosed with SLE and treated with belimumab were assessed clinical, serological and phenotypically at baseline, 4 and 8 months. Disease activity was evaluated using the SLEDAI score (Systemic Lupus Erythematosus Disease Activity Index). Remission was defined as SLEDAI<3, moderate disease activity as SLEDAI=3-12 and severe disease activity as SLEDAI>12. sBAFF, TNF-alpha and IL-17A serum levels were determined by ELISA. BC phenotyping was performed using multiparameter flow cytometry. A control group was evaluated to compare serological and phenotypical variables.

Results We found a progressively decreased disease activity measured by SLEDAI, absolute BC-CD19+ count and anti-DNA antibodies, whereas the platelet count increased progressively. Regarding sBAFF, TNF-alpha and IL-17A serum levels, these were persistently elevated in the SLE group compared to the control group. Furthermore, sBAFF serum levels increased while IL-17A and TNF-alpha decreased during follow up in the SLE group. We observed changes on BC phenotype in the SLE group when comparing with controls. In the SLE group, we observed a decrease in percentages (%) of BC-naïve (CD19+/CD27-) and an increase in % of BC-memory (CD19+/CD27+). Respect to BC subsets, we observed a decrease in the % of BC-naïve-mature (CD19+IgD+CD38+) and plasmablasts (CD19+IgD-CD38++), and an increase in BC-post-germinal-center (CD19+IgD-CD38+) and BC-memory-resting (CD19+/IgD+/CD38-). We found an inverse correlation of SLEDAI with both haemoglobin and C3 (p=0.046, p=0.01, respectively).

Conclusions Our results suggest that the response to belimumab in SLE patients might be associated with both a decrease in the percentages of BC-naïve and a progressive increase of sBAFF serum levels. These observations may be a potential indicator of therapeutic response, and these findings should be corroborated in larger cohorts and longer follow-ups.


  1. Kamal A, Khamashta M.Autoimmun Rev. 2014 Nov;13(11):1094-101.

  2. Liossis SN, Melissaropoulos K. Expert Opin Pharmacother. 2014 Apr;15(6):833-40.

  3. Lutalo PM, D'Cruz DP. Expert Opin Biol Ther. 2014 Nov;14(11):1701-8.

Disclosure of Interest None declared

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.