Benlysta approved for lupus nephritis: is it for mild cases?

Dr. T’s Answer:

Types of mild lupus nephritis-

“It all depends upon what your definition is of “mild nephritis.” I would consider ISN/RPS classes 1 (minimal mesangial) and 2 (mesangial proliferative) as mild. They do not need treatment at all (except for Plaquenil/hydroxychloroquine plus often an angiotensin receptor blocker, such as losartan, or an angiotensin converting enzyme inhibitor, such as lisinopril, medicine to lower protein in the urine).

In addition, lupus podocytopathy could also be considered a “mild” type of lupus nephritis. Usually, lupus podocytopathy goes into remission quickly with Plaquenil plus steroids, with a rapid steroid taper. Therefore, for my definitions of “mild” lupus nephritis, Benlysta is not needed.

The Benlysta lupus nephritis clinical trial (called BLISS-LN) showed that when Benlysta was added on top of standard of care (Plaquenil, steroids and either mycophenolate or cyclophosphamide) there were significantly more people who improved on Benlysta plus standard of care compared to those who were treated with standard of care alone. More patients had partial or complete responses (including remissions) compared to standard of care (i.e. how we treat lupus nephritis before Benlysta). Plus… there were no significant differences in side effects, which is amazing. Also, more patients who got placebo plus standard of care died or went into complete kidney failure compared to the Benlysta group.

This is all great news. The lupus community is excited about this landmark event: Benlysta being the first FDA-approved drug for lupus nephritis ever. “

Thanks to Kelli of “More than Lupus” for producing the “Ask Dr. T” series!

UPDATE September 2021: Lupkynis became the second FDA-approved drug for the treatment of lupus nephritis in January 2021.