Are there instances in which you would combine belimumab and rituximab for management of difficult to control SLE?

While I have not employed this combination in my own practice, I am aware of the proposed rationale that using belimumab and rituximab together could promote more sustained B-cell depression. This approach was tested in the BEAT-LUPUS trial, results published in Lancet Rheumatology in 2022. In this ...

I would not at this point. I'll await the results of the phase 3 clinical trial called the SynBioSe-2 trial.

I hesitate because:

BLISS-BELIEVE trial of 292 patients, IV belimumab (BEL) and two doses of rituximab, followed over 104 weeks, failed to meet the primary and secondary end points, and there w...

I use this combined approach in selective patients for whom B-cell depletion is needed to control disease activity, giving rituximab to expedite control of severe autoAb-mediated disease activity and then initiating belimumab for sustained disease control and minimizing risk of relapse. I would not ...

I'll point out a recent systematic review in "Lupus." The authors noted a high degree of adverse events, including 'serious adverse events'." (Voss & Reinert, PMID 41162843)

I'd still use obinutuzumab off-label, instead. I've had great success in extra-renal lupus with it. It is an improved version o...