Belimumab

 

What is Belimumab?

Belimumab is a targeted disease modifying anti-rheumatic drug (DMARD) that is used to reduce inflammation produced by the body. In certain diseases the immune system is over active, this can target healthy tissues such as joints and skin. Belimumab works on the inflammatory pathway to reduce the effects, thereby reducing the symptoms you get from arthritis, mouth ulcers and rashes.

 

What is Belimumab used for?

Belimumab is used for the treatment of systemic lupus erythematosus (SLE) when other medications have not worked to reduce the symptoms.

 

How is it taken?

Belimumab is given as an injection into the vein through a drip. This is called an intravenous infusion and is usually given in the rheumatology day unit. You will be monitored throughout and for 1-2 hours after this to make sure you have not developed and side effects.

 

The dose is calculated from your weight and it is given as a loading treatment initially, with infusions at 0, 2 and 4 weeks, it is then given every 4 weeks whilst you remain on the medication.

 

Medications to prevent a reaction to the drip are given at the same time; these include paracetamol and anti-histamines.

 

The medication can take up to 6 months to have the full effect. You will need your bloods monitored whilst you are on belimumab. This is initially done at 3 months and 6 months, and then just annually. However if you are also on another medication such as a DMARD that requires blood monitoring, you will need to continue this.

 

Side effects

There are a few possible side effects that can occur in a small number of people that take belimumab, these include:

 

• Feeling sick, vomiting, diarrhoea and headaches
  • These usually settle after taking the medication for a few weeks.
• Increased risk of infections
  • As belimumab dampens the immune system, you can be more prone to infection. You should be seen by your GP if you feel unwell in case you need antibiotics. You must temporarily stop your infusions whilst you are unwell and receiving treatment, they can be started up again when you feel well.
  • You should try to avoid contact with others that have chicken pox or shingles.
• Infusion reactions
  • Sometimes people can have a reaction whilst receiving the drip, this is reduced by the pre medications that are given. Your observations including blood pressure and pulse are regularly checked.
  • If you have a severe reaction, no further belimumab will be given.
• Risk of cancer
  • Medicine that suppresses the immune system may mean that cancerous growths can develop faster. There has not been an observed link in trials that belimumab can cause cancer.
• Progressive Multifocal Leukoencephalopathy (PML)
  • This is a very rare side effect where activation of a virus when triggered can affect the brain and spinal cord. If you develop dizziness, confusion and changes of feeling in your limbs, this should be checked straight away.

 

Cautions of use

Interactions with other medications

• Your doctor will check if there are any medications that could interact.
• You can carry on taking your usual painkillers including NSAIDs.

Contraindications of other conditions

• Before starting any biological therapy, your bloods will be checked for infections that can become active again when the immune system is suppressed, this includes hepatitis B, C and HIV. A blood and chest X-ray is taken to exclude previous TB exposure. If you are found to have had previous TB exposure you may need to start preventative antibiotics for a short period before the belimumab is commenced.
• If you are under investigation or diagnosed with cancer, belimumab should be stopped.

Operations

• If you are taking belimumab and require surgery, you should discuss this with your doctor or nurse specialist.

During pregnancy and breastfeeding

• There is currently limited data on belimumab in pregnancy and breastfeeding. Therefore it should not be used.
• If you are considering starting a family, belimumab should be stopped at least 4 months before trying to conceive.

Alcohol

• Alcohol and belimumab do not interact, however it is recommended to take alcohol within moderation, following the guidelines of less than 14 units weekly.

Vaccinations

• Flu and the pneumonia vaccine are safe and recommended whilst taking belimumab.
• Live vaccines including the shingles vaccine should not be given due to the dampening down of the immune system.

 

Useful Links 

Versus Arthritis: https://www.versusarthritis.org