Are there instances in which you would combine belimumab and rituximab for management of difficult to control SLE?

While I have not employed this combination in my own practice, I am aware of the proposed rationale that using belimumab and rituximab together could promote more sustained B-cell depression. This approach was tested in the BEAT-LUPUS trial, results published in Lancet Rheumatology in 2022. In this ...

I would not at this point. I'll await the results of the phase 3 clinical trial called the SynBioSe-2 trial.

I hesitate because:

BLISS-BELIEVE trial of 292 patients, IV belimumab (BEL) and two doses of rituximab, followed over 104 weeks, failed to meet the primary and secondary end points, and there w...

I'll point out a recent systematic review in "Lupus." The authors noted a high degree of adverse events, including 'serious adverse events'." (Voss & Reinert, PMID 41162843)

I'd still use obinutuzumab off-label, instead. I've had great success in extra-renal lupus with it. It is an improved version o...

I use this combined approach in selective patients for whom B-cell depletion is needed to control disease activity, giving rituximab to expedite control of severe autoAb-mediated disease activity and then initiating belimumab for sustained disease control and minimizing risk of relapse. I would not ...