{
  "abstract": "Objective To evaluate the efficacy, safety and predictive factors of belimumab (BEL)-based triple therapy in proliferative lupus nephritis (LN) in real-world settings.Methods We conducted a multicentre, retrospective study including patients with proliferative LN (new-onset or relapsing) who initiated BEL within 6 months of a renal flare, in combination with standard-of-care.Results 49 patients were included (mean age 37 years; 85.7% female; 67.3% Caucasian). The median time from renal flare to BEL initiation was 1 month (IQR 0–3). By 12 months, 67.3% achieved complete renal response (CRR), 75.5% primary efficacy renal response (PERR) and 83.7% at least partial renal response. Median proteinuria declined from 2.7 g/day to 0.49 g/day, with parallel improvement in estimated glomerular filtration rate (71 to 78 mL/min/1.73 m²). Patients with baseline proteinuria <3 g/day achieved significantly higher CRR (78.1% vs 47.1%; p=0.027) and PERR (84.4% vs 58.8%; p=0.048) rates.The mean glucocorticoid (GC) dose decreased from 31.7 mg/day at baseline to 3.5 mg/day at 12 months, and 26.1% of patients achieved complete GC withdrawal. Extrarenal disease activity was present in 81.6% of patients at baseline, predominantly articular and mucocutaneous, with clinically meaningful improvement in 80% during follow-up. At 12 months, 40.8% met remission by Definition Of Remission In Systemic Lupus Erythematosus (DORIS) criteria and 46.9% attained Lupus Low Disease Activity State (LLDAS). Renal treatment failure occurred in 16.3% and renal relapse in 4.1%. Adverse events were mild, and no serious BEL-related events were observed.Conclusion BEL-based triple therapy is effective and safe in proliferative LN, achieving high renal and extrarenal response rates, substantial GC-sparing and treat-to-target outcomes in real-world practice.",
  "authors": [
    {
      "affiliations": [
        "Rheumatology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Spain",
        "Universitat de Barcelona Facultat de Medicina i Ciencies de la Salut, Barcelona, Spain"
      ],
      "name": "Paola Vidal-Montal"
    },
    {
      "affiliations": [
        "Rheumatology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Spain"
      ],
      "name": "Aina Fabregat"
    },
    {
      "affiliations": [
        "Rheumatology, University Hospital San Roque, Las Palmas de Gran Canaria, Spain"
      ],
      "name": "Irene Altabás-González"
    },
    {
      "affiliations": [
        "Rheumatology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain"
      ],
      "name": "José María Pego-Reigosa"
    },
    {
      "affiliations": [
        "Rheumatology, Complejo Hospitalario Doctor Negrin, Las Palmas de Gran Canaria, Spain"
      ],
      "name": "Andrea Hernández-Martínez"
    },
    {
      "affiliations": [
        "Rheumatology, Complejo Hospitalario Doctor Negrin, Las Palmas de Gran Canaria, Spain"
      ],
      "name": "Iñigo Rua-Figueroa"
    },
    {
      "affiliations": [
        "Rheumatology, Hospital del Mar, Barcelona, Spain"
      ],
      "name": "Tarek Salman-Monte"
    },
    {
      "affiliations": [
        "Rheumatology, Complejo Asistencial Universitario de León, Barcelona, Spain"
      ],
      "name": "Clara Moriano"
    },
    {
      "affiliations": [
        "Rheumatology, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain"
      ],
      "name": "Beatriz Tejera Segura"
    },
    {
      "affiliations": [
        "Rheumatology, Hospital General Universitario Dr Balmis, Alicante, Spain"
      ],
      "name": "Paloma Vela"
    },
    {
      "affiliations": [
        "Rheumatology, Infanta Leonor Hospital, Madrid, Spain"
      ],
      "name": "Ana Pareja-Martínez"
    },
    {
      "affiliations": [
        "Rheumatology, Parc Taulí Hospital Universitari, Sabadell, Spain"
      ],
      "name": "Silvia García-Cirera"
    },
    {
      "affiliations": [
        "Rheumatology, Hospital Universitario Ramon y Cajal, Madrid, Spain"
      ],
      "name": "María Jesús García-Villanueva"
    },
    {
      "affiliations": [
        "Rheumatology, Hospital Universitario Ramon y Cajal, Madrid, Spain"
      ],
      "name": "Sandra Garrote-Corral"
    },
    {
      "affiliations": [
        "Rheumatology Department, Hospital Moisès Broggi, Barcelona, Spain"
      ],
      "name": "Sergi Heredia"
    },
    {
      "affiliations": [
        "Rheumatology, Hospital Sierrallana, Torrelavega, Spain"
      ],
      "name": "Leyre Riancho-Zarrabeitia"
    },
    {
      "affiliations": [
        "Hospital Regional Universitario Carlos Haya, Malaga, Spain"
      ],
      "name": "Sara Manrique-Arija"
    },
    {
      "affiliations": [
        "Rheumatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain"
      ],
      "name": "Julia Bernárdez"
    },
    {
      "affiliations": [
        "Rheumatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain"
      ],
      "name": "Berta Magallares"
    },
    {
      "affiliations": [
        "Rheumatology, Hospital Comarcal de l'Alt Penedès, Vilafranca del Penedès, Spain"
      ],
      "name": "Vicenç Torrente-Segarra"
    },
    {
      "affiliations": [
        "Rheumatology Department, Hospital Clinic de Barcelona, Barcelona, Spain"
      ],
      "name": "Beatriz Frade-Sosa"
    },
    {
      "affiliations": [
        "Rheumatology Department, Hospital Clinic de Barcelona, Barcelona, Spain"
      ],
      "name": "José Alfredo Gómez-Puerta"
    },
    {
      "affiliations": [
        "Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain"
      ],
      "name": "Julia Martinez-Barrio"
    },
    {
      "affiliations": [
        "Rheumatology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Spain",
        "Universitat de Barcelona Facultat de Medicina i Ciencies de la Salut, Barcelona, Spain"
      ],
      "name": "Javier Narvaez"
    },
    {
      "affiliations": [],
      "name": "on behalf of the BELIMUMAB Multicenter Spanish Register Group (BEL-SPAIN)"
    }
  ],
  "title": "Real-world experience with belimumab-based triple therapy in proliferative lupus nephritis: data from the BEL-SPAIN Registry",
  "uid": "69ea8187-86be-56b6-aa65-792bf1893085"
}