Summary

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• This summary is based on the review of 17 systematic review(s)/meta-analysis(es). ^[1-17]
• Belimumab showed significant efficacy in achieving complete renal remission in lupus nephritis patients (odds ratio (OR) = 2.78, 95% confidence interval (CI) = 1.81-4.26), surpassing standard therapy and comparable to multitarget therapy, obinutuzumab, and voclosporin. Combined with standard therapy, belimumab improved total renal response rates (relative risk (RR) = 1.31, 95% CI = 1.11-1.53) and complete renal response rates (RR = 1.47, 95% CI = 1.07-2.02).
• Belimumab effectively reduced systemic lupus erythematosus (SLE) Disease Activity Index (SLEDAI) scores (RR = 1.28; 95% CI = 1.16-1.40; P < 0.00001) and lowered SLE flare rates and prednisone-equivalent dosing requirements. Superior disease control was observed in extrarenal SLE and lupus nephritis relative to standard care.
• Belimumab efficacy was comparable to obinutuzumab and multitarget therapy in lupus nephritis, with slightly lower efficacy than obinutuzumab in some analyses. It showed more consistent primary endpoint achievement in trials compared to rituximab.
• Higher efficacy was noted in patients with elevated baseline disease activity, serologically active individuals, and younger patients (≤18 years). Real-world data confirmed consistent efficacy across gender and age demographics.
• No significant difference in the incidence of adverse events (AEs) or serious adverse events (SAEs) between belimumab and placebo; SAEs were lower in the belimumab group.
• Belimumab plus standard therapy significantly reduced the risk of renal flare (RR = 0.51; 95% CI = 0.37-0.69) and progression to end-stage renal disease (ESRD) (RR = 0.56; 95% CI = 0.40-0.79).
• Belimumab demonstrated a comparable safety profile to other biologics, with no significant differences in serious infections or withdrawals due to adverse events compared to placebo.
• Higher efficacy was observed in younger patients (≤18 years), those with elevated baseline disease activity, and serologically active individuals; efficacy and safety findings were consistent across patient demographics, including gender and age, with further study recommended for non-Asian populations in multitarget therapy effectiveness.