Belimumab combined with mycophenolate mofetil for treating severe lupus nephritis: effects on renal recovery, immune regulation, and long-term prognosis.

OBJECTIVE

To assess the combined therapeutic effects of belimumab and mycophenolate mofetil (MMF) in severe lupus nephritis (LN), focusing on renal recovery, immune regulation, and long-term outcome.

METHODS

We retrospectively analyzed data from 188 patients hospitalized between March 2019 and April 2022. Of these, 106 received belimumab (10 mg/kg) in addition to standard therapy, while 82 received standard care alone. Endpoints included renal function indices (proteinuria, serum creatinine, albumin), Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores, anti-dsDNA antibody titers, complement C3 and C4 levels, and inflammatory markers (hs-CRP, IL-6, TNF-α). Remission rates were calculated, and prognostic factors for end-stage renal disease (ESRD) and mortality were evaluated using Cox regression and competing risk analysis.

RESULTS

The combination therapy yielded a 94% remission rate, significantly higher than the 70% observed for controls (P<0.001). Complete remission was achieved in about 50% of treated patients, compared to 40% in the control group (P=0.025), with a notably lower non-responder rate. Belimumab-treated patients exhibited greater reductions in proteinuria, serum creatinine, SLEDAI score, erythrocyte sedimentation rate (ESR), and inflammatory cytokines, alongside increases in albumin and complement levels (all P<0.001). Baseline creatinine and albumin levels were consistent predictors of ESRD (P<0.001) and mortality (P=0.006) by multivariate and competing risk analyses.

CONCLUSION

In severe LN, the combination of belimumab and MMF provided superior improvements in renal function, immune status, and long-term prognosis compared to standard therapy. Baseline renal biomarkers, particularly creatinine and albumin, may guide patient stratification and personalized treatment approaches.