Next Chapter After Belimumab: Anifrolumab to the Rescue

Madalina-Pusa Rosu^(1,*), Valentina Petricescu⁽¹⁾, Cristina Iosif⁽²⁾, Narcis Copca^(3,4), Denisa Predeteanu⁽¹⁾

1) Department of Rheumatology, “Sf. Maria” Clinical Hospital, Bucharest, Romania
2) Department of Pathology, "Sf. Maria" Clinical Hospital, Bucharest, Romania
3) Department of Surgery II, “Sf. Maria” Clinical Hospital, Bucharest, Romania
4) Department of Research Center University of Medicine “Carol Davila”, Bucharest, Romania

Belimumab is a human immunoglobulin G1-lambda-1 (IgG1-λ) monoclonal antibody that is specific for soluble BLyS human protein, also known as B-cell activating factor (BAFF). Serious and sometimes fatal infections have been reported in patients receiving immunosuppressive agents, including belimumab.
On the other hand, anifrolumab blocks the type I interferon receptor (IFNAR1) intercepting interferon-driven immune activation.
Because BAFF and IFNAR1 act in different immune pathways, switching from belimumab to anifrolumab can provide benefit when one axis alone isn’t sufficient.
Physicians should exercise caution when considering biological therapy in patients with systemic lupus erythematosus (SLE), which is a chronic, debilitating, and usually progressive autoimmune disease in which the body’s immune cells secrete antibodies that attack its own tissues.
This is a compelling and rare case of a woman with SLE who developed Toxic Epidermal Necrolysis (TEN) after treatment with belimumab, and who went to experience a remarkable clinical recovery with anifrolumab – six years later.

Keywords: systemic lupus erythematosus, autoimmune disease, toxic epidermal necrolysis, belimumab, anifrolumab

Corresponding author(s): Madalina Pusa Rosu, Department of Rheumatology, "Sfanta Maria" Clinical Hospital, Bucharest, Romania, email: madalina.duna@yahoo.com