Systemic Lupus Erythematosus: Indirect B-Cell Blocking

The use of B-cell depleting agents in clinical practice in systemic lupus erythematosus (SLE), overwhelmingly restricted to off-label therapy with rituximab, currently centers on patients unresponsive or intolerant to standard of care therapy, or with life-threatening presentations. Four B-cell depleting agents deserve specific mention: rituximab, use of which is reported in nearly 1,500 patients with SLE (1,000 in uncontrolled studies); ocrelizumab, trials of which were halted in 2010 owing to an association with unexpectedly high rates of severe infections; epratuzumab, which has been tested in trials that enrolled nearly 300 patients with SLE; and belimumab, tested in more than 2,000 patients with SLE overwhelmingly included in controlled trials. Belimumab has been licensed for use in SLE in 2011 by the FDA and European Medicines Agency. Forthcoming years will show the real value of B-cell targeted therapies, including the off-label use of rituximab and especially the licensed use of belimumab, as part of the standard of care in patients with SLE.