ウチダ　ケイコ   UCHIDA Keiko   内田　啓子    所属   医学部 医学科（東京女子医科大学病院）    職種   客員教授
論文種別	原著
言語種別	英語
査読の有無	査読なし
表題	Successful Treatment with Belimumab in a Patient with Refractory Systemic Lupus Erythematosus after Initiation of Hemodialysis: Considering the Synergistic Effect of Belimumab and Immunological Burn-Out Phenomenon in End-Stage Renal Disease Patients on Hemodialysis
掲載誌名	正式名：Blood purification 略　 称：Blood Purif ISSNコード：14219735/02535068
掲載区分	国外
巻・号・頁	51(2),pp.182-188
著者・共著者	Karasawa Kazunori, Ogura Shota, Takabe Tomo, Miyabe Yoei, Iwabuchi Yuko, Akiyama Kenichi, Sato Masayo, Moriyama Takahito, Uchida Keiko, Nitta Kosaku
発行年月	2021/04/23
概要	BACKGROUND:In patients with systemic lupus erythematosus (SLE), disease activity can persist even after initiating dialysis. However, guidelines for the treatment of patients with SLE after dialysis is initiated have not yet been established.CASE PRESENTATION:We describe the case of a 54-year-old Japanese woman who was diagnosed with SLE at age 12, progressed to end-stage renal disease (ESRD), and initiated hemodialysis for lupus nephritis. However, SLE activity persisted after hemodialysis. Cyclophosphamide and mycophenolate mofetil were administered in addition to prednisolone and immunoadsorption, but this treatment strategy was limited by side effects. The patient was subsequently treated with belimumab, and the activity of SLE decreased rapidly.CONCLUSIONS:ESRD patients with SLE show no significant decrease in transitional B cells and have elevated levels of B-cell activating factor (BAFF). Both transitional B cells and BAFF are important therapeutic targets for belimumab, indicating that patients with ESRD may benefit from belimumab therapy. However, the effects of belimumab may be potentiated in patients with uremia, who may be more susceptible to adverse events such as infections. Patients with SLE who receive belimumab after initiation of hemodialysis therefore require careful follow-up. Here, we report the first case of belimumab administration in a patient with SLE after initiation of hemodialysis.
DOI	10.1159/000512585
PMID	33895749