Benlysta (belimumab) is a monoclonal antibody approved to treat people with active, autoantibody-positive systemic lupus erythematosus (SLE). It works by blocking the activity of a protein found in these types of SLE, decreasing the production of autoantibodies.

SLE is an autoimmune disease, or a disease in which the immune system produces autoantibodies that attack healthy parts of the body, such as the joints, skin, blood vessels, and different organs.

How Benlysta works

Antibodies are proteins used by the immune system to identify and neutralize pathogens, such as bacteria and viruses, or other foreign invaders. But problems can arise and autoantibodies appear; autoantibodies are proteins that react with antigens in healthy tissues or organs, leading to autoimmune diseases. SLE is characterized by excessive autoantibody production.

Autoantibodies are produced by a type of immune system cell called B-lymphocytes, which mature into autoreactive plasma cells.

People with SLE are known to have high levels of B-lymphocyte stimulator (BLyS) proteins that play a major role in B-lymphocyte survival by preventing natural process of cellular death, called apoptosis. High BLyS levels eventually dysregulate the immune system in SLE, allowing for the survival and proliferation of B-lymphocytes, which in turn produce more autoantibodies.

Benlysta was developed to treat SLE by blocking soluble BLyS. It binds to soluble BLyS, preventing it from binding to B-lymphocytes and allowing more B-lymphocytes to undergo apoptosis. This reduces the differentiation of B-lymphocytes into autoreactive B-lymphocytes, plasma cells that produce immunoglobulins. By reducing the autoreactive B-lymphocyte population, Benlysta decreases the production of autoantibodies.

Benlysta does not deplete B-lymphocytes directly nor does it directly bind to B-lymphocytes.

Interestingly,this drug may not be effective in treating African-Americans who have SLE. In exploratory analyses of Phase 3 studies, black patients had a lower response rate than blacks in the placebo group. Caution, for this reason, is advised when considering this treatment for this population.

Other details

Benlysta comes as a powder to be mixed with sterile water and given intravenously over at least one hour. It is usually given by a doctor or nurse once every two weeks for the first three doses, and then once every four weeks. The treatment’s benefits may take time to be fully felt.

SLE patients being treated with Benlysta should be closely monitored by a healthcare practitioner, and they should reports reactions that can include rash or hives; itching; swelling of the face, eyes, mouth, throat, tongue or lips; difficulty breathing and swallowing; fever or other signs of infection; chest pain or discomfort; seizures; bloody diarrhea; difficult or frequent urination; and new or worsening anxiety or depression.

Common adverse reactions are nausea, diarrhea, flu-like symptoms, insomnia, pain in extremities, depression, headache, urinary infection, and low B-lymphocyte count.

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