Search

Although disappointing, the results of the ILLUMINATE trials are read with great attention.1 ,2 These trials assessed the efficacy of tabalumab, a B lymphocyte stimulator (Blys) inhibitor, in systemic lupus erythematosus (SLE). Unfortunately, the results were not considered by Lilly worth following the development of this new agent, of the same therapeutic class than belimumab, the first biologic to be labelled in SLE.3 ,4 Overall, what retained our attention were the similarities between designs and results of ILLUMINATE and BLISS studies, while the fates of the two corresponding drugs were so different (table 1). View this table: Table 1 Phase III studies conducted in non-renal patients with SLE targeting Blys Indeed, apart from slight differences in the design concerning the management of standard of care treatments, the inclusion of patients from different countries and the choice of a different cut-off for the outcome criteria, these four studies addressed large populations of patients with SLE with similar characteristics that were evaluated with the same composite outcome measure SLE Responder Index5 and showed only a modest (around 10%) response rate difference between active treatment and placebo. Notably, there were differences between the two ILLUMINATE studies as observed between the two BLISS studies (table 1). A significant …

Objectives Lupus nephritis (LN) is a major cause of morbidity in patients with systemic lupus erythematosus (SLE). B cells have a central role in the pathogenesis of SLE. B lymphocyte stimulator (BLyS) and a proliferation inducing ligand (APRIL) are pivotal in B cell homeostasis. We aimed to investigate a potential role of serum BLyS and APRIL as biomarkers in LN, especially as predictors of treatment response. Methods Sixty-four patients with active LN (52 proliferative lupus nephritis (PLN); 12 membranous LN) were included. Renal biopsies were performed at baseline and after immunosuppressive treatment. Serum levels of BLyS, APRIL and autoantibodies were measured on both biopsy occasions and in 64 individually matched controls. Renal biopsies were evaluated using the International Society of Nephrology/Renal Pathology Society classification, and scored for Activity Index and Chronicity Index. Clinical responders (CR) were required to have ≥50% reduction in proteinuria, normal or improved renal function, and inactive urinary sediment. Histopathological responders (HR) were required to have ≥50% improvement in Activity Index. Results Baseline BLyS levels were significantly higher in LN patients compared with controls (p