BACKGROUND: Belimumab (Benlysta) is currently approved for the treatment of 
active Lupus despite standard therapy. Few data are available on the efficacy of 
this drug in lupus nephritis (LN).
METHODS: 17 LN female followed in two Nephrology Italian Unit received belimumab 
for a median period of 36 months (range 6-42 months). The indications were: 
arthralgia in 3 patients, cutaneous manifestations in 2, residual proteinuria in 
8, and the need to reduce steroids for severe side effects in 4. Of interest, 1 
patient started therapy during Peritoneal Dialysis and continued after kidney 
transplantation due to non-responsive arthralgias.
RESULTS: Arthralgia and skin manifestations resolved in all patients. 
Proteinuria normalized in three patients and stabilized in all but one of the 
others. Steroids were indefinitely stopped in six patients (35%) and reduced to 
around 40% of the basal dosage in the other patients. During belimumab therapy, 
three extrarenal and one renal SLE flares were diagnosed accounting for a rate 
of renal flares of 0.02/patient/year. No major adverse events leading to therapy 
withdrawal occurred.
CLINICAL CASE: Arthralgia resolved, immunological parameters improved and 
prednisone could be reduced within few months in the patient who started 
belimumab during peritoneal dialysis. After kidney transplantation belimumab was 
stopped but due to arthralgias unresponsive to standard immunosuppressive 
therapy it was restarted with success.
CONCLUSIONS: Belimumab allows the achievement of complete response together with 
the withdrawal or the reduction of corticosteroids in almost all our patients. 
Of interest its satisfactory use in a patient in peritoneal dialysis and after 
kidney transplantation.