As reported on MedScape, gradually extending the interval between belimumab doses may allow carefully selected patients with systemic lupus erythematosus (SLE) in long-term remission to reduce treatment exposure (and in some cases stop therapy) without triggering disease flares, according to a small retrospective study from Italy.
Investigators reviewed outcomes for 152 adults with SLE who received belimumab at four Italian centers between 2013 and 2025. Eligibility for a tapering approach required at least 2 years of belimumab treatment and more than 6 months without a flare.
Among the overall cohort, 22 patients underwent a planned dose-spacing strategy. Subcutaneous belimumab intervals were progressively extended from every 10 days to every 28 days, while intravenous treatment intervals were increased from every 6 weeks to every 16 weeks before possible discontinuation. Patients were followed for a median of 21 months.
No flares were observed in the dose-spacing group during follow-up. In addition, none of the patients required a higher glucocorticoid dose or needed to return to a more frequent belimumab schedule. Seven participants ultimately discontinued belimumab successfully, and the study reported no deaths or worsening of cumulative organ damage.
Patients selected for interval extension tended to have longer periods of remission and lower baseline SLE Disease Activity Index 2000 scores. Both factors were statistically associated with allocation to the dose-spacing strategy. Glucocorticoid use also declined as patients moved through progressively less frequent belimumab administration.
The findings suggest that treatment de-escalation may be feasible for a subset of patients with stable, inactive SLE. However, the results should be interpreted cautiously. The study included only 22 patients who underwent dose spacing, used a retrospective design, and did not include a comparison group. Participants were also selected because their disease was already clinically quiet, limiting how broadly the findings can be applied.
The authors emphasized the need for individualized decisions during remission, balancing the potential consequences of relapse against the risks and burden of ongoing immunosuppression.
