Benlysta (belimumab)

Company
Human Genome Sciences

Approval Status
Approved March 2011

Treatment for
systemic lupus erythematosus

Areas
Immune System

Benlysta (belimumab) is a human IgG 1 À monoclonal antibody specific for soluble human B lymphocyte stimulator protein (BLyS). Elevated levels of BLyS are seen in the blood or joint fluid of patients with autoimmune and inflammatory disorders.

Benlysta is specifically indicated for the treatment of adult patients with active, autoantibody-positive, systemic lupus erythematosus who are receiving standard therapy.

Benlysta is supplied as a solution for intravenous infusion. It must be reconstituted and diluted prior to intravenous administration The recommended initial dose is 10 mg/kg at 2-week intervals for the first 3 doses and at 4-week intervals thereafter. It should be administered as an intravenous infusion over a period of 1 hour. The infusion rate may be slowed or interrupted if the patient develops an infusion reaction.

FDA Approval
The FDA approval of Benlysta was based on three randomized, double-blind, placebo-controlled studies involving 2,133 patients with SLE.
Trial 1: Benlysta 1 mg/kg, 4 mg/kg, 10 mg/kg
Trial 1 enrolled 449 subjects and evaluated doses of 1, 4, and 10 mg/kg Benlysta plus standard of care compared with placebo plus standard of care over 52 weeks. The co-primary endpoints were percent change in SELENA-SLEDAI score at Week 24 and time to first flare over 52 weeks. No significant differences between any of the Benlysta groups and the placebo group were observed. Exploratory analysis of this study identified a subgroup of subjects (72%), who were autoantibody positive, in whom Benlysta appeared to offer benefit. The results of this study informed the design of Trials 2 and 3 and led to the selection of a target population and indication that is limited to autoantibody-positive SLE patients.
Trials 2 and 3: Benlysta 1 mg/kg and 10 mg/kg
Trials 2 and 3 were randomized, double-blind, placebo-controlled trials in patients with SLE that were similar in design except - Trial 2 was 76 weeks duration and was conducted in North America and Europe.and Trial 3 was 52 weeks duration and was conducted in South America, Eastern Europe, Asia, and Australia. At screening, subjects were stratified by disease severity based on their SELENA-SLEDAI score, proteinuria level and race (African or Indigenous-American descent vs. other), and then randomly assigned to receive Benlysta 1 mg/kg, 10 mg/kg, or placebo in addition to standard of care. Treatment was administered intravenously over a 1-hour period on Days 0, 14, 28, and then every 28 days for 48 weeks in Trial 3 and for 72 weeks in Trial 2. The primary efficacy endpoint was a composite endpoint (SLE Responder Index or SRI) that defined response as meeting each of the following criteria at Week 52 compared with baseline:
≥4-point reduction in the SELENA-SLEDAI score, and
no new British Isles Lupus Assessment Group (BILAG) A organ domain score or 2 new BILAG B organ domain scores, and
no worsening (<0.30-point increase) in Physician’s Global Assessment (PGA) score
In both Trials 2 and 3, the proportion of SLE patients achieving an SRI response, as defined for the primary endpoint, was significantly higher in the Benlysta 10 mg/kg group than in the placebo group. The trends in comparisons between the treatment groups for the rates of response for the individual components of the endpoint were generally consistent with that of the SRI. At Week 76 in Trial 2, the SRI response rate with Benlysta 10 mg/kg was not significantly different from that of placebo (39% and 32%, respectively).

Adverse effects associated with the use of Benlysta may include, but are not limited to, the following:

  • nausea
  • diarrhea
  • pyrexia
  • nasopharyngitis
  • bronchitis
  • insomnia
  • pain in extremity
  • depression
  • migraine
  • pharyngitis

Benlysta (belimumab) is a human IgG 1 À monoclonal antibody specific for soluble human B lymphocyte stimulator protein (BLyS). It blocks the binding of soluble BLyS, a B-cell survival factor, to its receptors on B cells. Benlysta does not bind B cells directly, but by binding BLyS, it inhibits the survival of B cells, including auto reactive B cells, and reduces the differentiation of B cells into immunoglobulin-producing plasma cells.

For additional information regarding Benlysta or systemic lupus erythematosus please visit the Benlysta web page.

Benlysta Drug Information

The Benlysta drug information shown above is licensed from Thomson CenterWatch. The information provided here is for general educational purposes only and does not constitute medical or pharmaceutical advice which should be sought from qualified medical and pharmaceutical advisers.

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