A clinical trial (called “BEAT-Lupus”) has found that using a combination of two biologic treatments, rituximab and belimumab, may be more effective than using rituximab alone in patients who have not responded well to other treatment. They also found that people with a particular indicator in their blood may respond better to this combined treatment.

In 2019 LUPUS UK contributed £23,644 towards part of this study, with the largest contributions of the £2million total costs sourced from VersusArthritis and GlaxoSmithKline (GSK), with other smaller contributions from the Medical Research Council (MRC) and the National Institute for Health Research (NIHR)

Background

Everyone with lupus can have different symptoms and respond differently to medications, with treatments working well for some people and not for others. It can be difficult to predict who will respond best to which treatment.

There are several different treatments used for lupus. If people don’t respond well to the usual treatments, they are sometimes offered biologic treatments, which target specific parts of the immune system. Rituximab is the most commonly used biologic for lupus in the UK, but another, called belimumab, is also approved for use. However, there can be a lot of variation in how people respond to rituximab, with some people still experiencing flares of their lupus despite being treated with it.

What did this trial do?

The BEAT-Lupus trial aimed to test whether a combination of rituximab and belimumab could be more effective than rituximab alone. It also tried to find out if there was a way of predicting who might respond best to the combined treatment.

They worked with 52 patients over a year, and gave half of them rituximab alone, and the other half rituximab followed by belimumab. They compared the levels of lupus disease activity in the two groups, and used artificial intelligence (AI) to see if there were any biological indicators that could predict how someone would respond to the combined treatment.

What did they find out?

The main findings were:

• People on the combined treatment had fewer severe flares and a reduced level of signs in their blood that are associated with lupus disease activity. This suggests the combination of rituximab and belimumab could be a more effective treatment than rituximab alone.
• An indicator in the blood (called a “biomarker” – in this case a specific antibody) could predict whether someone will have a better response to the combined treatment of rituximab and belimumab.

 

You can read the full scientific paper on the combined treatments HERE, and the paper on the biomarker HERE.

How would this help patients?

If these findings can be confirmed in more patients, then it means a blood test could be developed to predict who might respond best to a combination of rituximab and belimumab. Those people could be offered a combined treatment.

Paul Howard, CEO of LUPUS UK, said:

“There are two really important findings here. Firstly, we are currently quite restricted with treatment options for lupus. Therefore, learning how we can use the available treatments most effectively is vital. This study shows that combining two separate treatments may be more effective.

“The other really important finding is a biomarker which could predict how someone may respond to this treatment combination. At present, treatment of lupus is too reliant on a “trial and error” approach until the best suited medication is identified. This can potentially take a long time, delaying essential improvements in quality of life. We need to know which treatment(s) are likely to help a patient most at the point of diagnosis and this brings us a step closer to that”

What happens next?

The findings need to be confirmed in larger trials with more people and with different groups of people (for example people of different ethnicities). The researchers are currently working on doing this. The combined treatment is not currently being offered in clinical practice as more research needs to be done.