Would you stop belimumab in a patient with SLE starting ravulizumab (C5 inhibitor) for myasthenia gravis due to concern for additive immunosuppression?
Answer from: at Academic Institution
This is a good question for which there is not a definitive response in the literature. Benlysta has a fairly low rate of related infections though not studied in relation to the ravulizumab. Obviously, the patient should be fully vaccinated against meningitis. I would also want to assess how well t...
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Answer from: at Community Practice
Reading on ravulizumab, I noticed some discussion specific to vaccination for encapsulated organisms (meningococcus) as well as warnings specific for gonorrhea. The reference also discussed using antimicrobial prophylaxis for 2 weeks starting therapy as well as waiting 2 weeks after stopping in anot...
Answer from: at Community Practice
As mentioned by @Gary Gilkeson and @Paul J. DeMarco, this is a tough one, has not been studied, and absolutely needs protection from meningococcus.
Personally, I'd feel nervous about using both biologics.
Interestingly, ravulizumab could theoretically help proliferative lupus nephritis (LN) based ...