Belimumab (Intravenous)

Belimumab is a drug prescribed by doctors to treat the symptoms of systematic lupus erythematosus (commonly known as lupus, or SLE in its milder form).

Overview

Belimumab, a drug prescribed by doctors to treat the symptoms of systematic lupus erythematosus (commonly known as lupus, or SLE in its milder form), is used in conjunction with other therapies and medicines to control the condition.

Lupus is a disease that can affect people on a number of levels - from very mild to severe and life-threatening. It happens when, for unknown reasons, the body's immune system starts to attack healthy skin, tissues and organs. Lupus (the term often used to describe its most severe form) and SLE (the milder form) can often impact severely on a person's quality of life and can be a very distressing illness even in the mildest cases. Symptoms usually experienced include skin rashes and hives, pain in the joints and swelling in various parts of the body. The disease can affect any person and any part of the body. However, it is more common in women of child-bearing age, and in women of African or Afro-Caribbean descent. It is also thought that lupus and SLE are triggered by genetics.

Belimumab is used to ease the unpleasant symptoms associated with lupus and SLE, although there is currently no cure for the disease. Regular injections of belimumab can help to control the disease, preventing it from progressing and becoming life-threatening. It is only to be administered by a doctor, for which regular appointments will be set.

Belimumab works by changing the immune system, helping the body to control the symptoms of lupus. It is an antibody that helps to reverse the detrimental actions of an immune system causing lupus, preventing it from attacking healthy tissue, skin and organs.

Most uses of belimumab are trouble-free. However, there have been some very rare cases where the use of belimumab has led to infections in the brain that have caused long-term damage and even death. Healthcare professionals can help to lower that risk by considering the full medical history of a patient before prescribing the treatment. Patients should always share their full medical history with their doctor to ensure their prescription is suitable for them.

Conditions treated

  • Lupus
    SLE

Type of medicine

  • Injection - supplied as a powder to make a solution

Side effects

When taking this medication, you may notice some changes in your body, particularly at the start of your treatment. This is normal, and most people take belimumab without any problems. There are various minor side effects that are commonplace with this medication, and are usually nothing to worry about. However, if your symptoms persist, or if the side effects become too uncomfortable, you should consult your doctor for advice. These are the common side effects:

  • Drowsiness
  • Nausea
  • Chills or fever
  • Coughing
  • Headache
  • Slight pain at the area of injection

Occasionally, there are rarer side effects of taking this drug that require urgent medical attention. If you experience any of the following, you should contact your doctor right away. Your medication will usually be stopped to prevent these serious side effects from developing, and you will likely be put on a different prescription. These are the less common side effects you should be aware of:

Infections

  • Pain urinating
  • Need to urinate often
  • Chills
  • Fever
  • Coughing, often with mucus
  • Swollen skin, painful to touch
  • Shortness of breath

Allergic reactions

  • Swelling of the lips, face, mouth, throat or tongue
  • Itchiness
  • Trouble breathing
  • Lower blood pressure than normal
  • Dizziness
  • Headache
  • Skin rash anywhere on the body
  • Nausea or vomiting
  • Fainting

Mental health deterioration

  • Harmful thoughts of suicide
  • Difficulty sleeping (insomnia)
  • Self-harm
  • Thoughts of harming others
  • Depression
  • Anxiety
  • Changes in the behaviour

Heart issues

  • Shortness of breath
  • Nausea or vomiting
  • Cold sweats
  • Chest tightening
  • Pain in the chest
  • Pain in upper body

Dosage

The dosage prescribed is set depending on a patient's individual body weight. Patients will be given a course of 10 mg per kilogram of weight. This dosage will be administered by a qualified healthcare professional, once on the first day of treatment, and then on days 14 and 28. After this, the injection will be given at four-week intervals. This treatment will continue under strict monitoring of the patient's progress. If there is no improvement in the patient's lupus or SLE condition within six months of starting the treatment, it will usually be discontinued and an alternative medication or treatment may be sought.

Major drug interactions

Patients should always tell their doctor if they are taking any other medication - either prescription or counter drugs. This is because there are some drugs that can react with others, causing unwanted and unknown side effects that can be dangerous or detrimental to a patient's health. Occasionally, some drugs will cause others to be ineffective, and your condition could worsen as a result of combining them.

There are 29 major drug interactions with belimumab:

  • adalimumab
  • bcg
  • certolizumab
  • clozapine
  • etanercept
  • fingolimod
  • golimumab
  • infliximab
  • influenza virus vaccine, h1n1, live
  • influenza virus vaccine, live, trivalent
  • leflunomide
  • measles virus vaccine
  • measles virus vaccine, mumps virus vaccine, rubella virus vaccine
  • measles virus vaccine, mumps virus vaccine, rubella virus vaccine, varicella virus vaccine
  • measles virus vaccine, rubella virus vaccine
  • mumps virus vaccine
  • mumps virus vaccine, rubella virus vaccine
  • natalizumab
  • poliovirus vaccine, live, trivalent
  • rotavirus vaccine
  • rubella virus vaccine
  • smallpox vaccine
  • talimogene laherparepvec
  • teriflunomide
  • tofacitinib
  • typhoid vaccine, live
  • varicella virus vaccine
  • yellow fever vaccine
  • zoster vaccine live

There are also many other drugs that are found to interact with belimumab on a lesser scale, including 65 moderate and 19 minor interactions. [ref 1] Always tell your doctor about other prescriptions, as this may alter your suitability for the drug, or may alter the dosage given to you.

Warnings

Disease interactions

There are several diseases that, like other drugs, can interact with your medication and cause unknown side effects. In some cases, belimumab may make your other conditions worse, or its effectiveness could be reduced. These diseases or conditions are:

  • Depression
  • Vaccination
  • Infections
  • Pml

Tell your doctor if you suffer from or have had one or more of the above - or any other conditions. Belimumab may not be suitable for you based on your medical history, or your dose may be altered.

Pregnancy

There is no evidence to suggest that belimumab causes harm to unborn babies, but pregnant mothers should be aware that the risk is not ruled out. Your doctor will be able to judge whether the benefits of taking the drug outweigh the risks.

Foods and alcohol

Although there are no major food or alcohol interactions while taking belimumab, it is recommended that patients reduce or cut out their alcohol intake. It is recommended that women keep their alcohol intake to one drink per day, and men to two drinks per day maximum. Alcohol can create worsened side effects of the drug and can create a vulnerability to developing headaches, nausea, dizziness, confusion and lack of judgement. It can also leave patients more open to changes in mental health, as well as depression and mood swings.

It is recommended that patients stick to a healthy diet while taking belimumab. This helps to keep the body and its immune system strong, helping to fight common infections and prevent the contraction of other diseases. A healthy diet can also help to prevent exhaustion and nausea.

Missed doses

Belimumab works best when it is administered at the recommended time periods. Doctors will set patients regular appointments to visit the hospital at the required times. It is important to stick to these appointments. If you miss an appointment - and therefore a dose of belimumab - try to arrange a time with your doctor as soon as possible. Missing or delaying treatment may lessen the effectiveness of the treatment and result in continued symptoms of lupus. It will also be more difficult for the doctor to monitor your progress and receptiveness to the medication.

Storage

Belimumab must be kept refrigerated at all times, in temperatures of between 2 - 8 degrees centigrade. Do not freeze belimumab powder or solution.

Belimumab must be stored by a healthcare professional in a safe and controlled environment. It should always be kept in the original packaging. Belimumab will come supplied with a sealed rubber stopper and aluminium seal. Keep away from light and heat sources. Once the solution has been removed from the packaging, use it in its solution form within 24 hours. Keep refrigerated during that time.

Summary

Belimumab is usually a safe treatment for lupus and SLE, and is used by people of all ages and backgrounds. Due to the nature of lupus - in that it is common in women of child-bearing age - it has been found to be low-risk for those that are pregnant. However, this should be approached with caution and risk cannot be ruled out.

There is a risk of serious side effects when taking a course of belimumab, so users should proceed with care. Patients can help to reduce their risk of harm from taking the medication by telling their doctor as much information about their medical history as possible, and always reporting any side effects experienced. Belimumab is only administered by a doctor, so the patient will be closely monitored, and tests taken at each appointment. However, patients should be aware of side effects developing in between appointments, and must report back on the progress of the drug.

Belimumab is effective when used in conjunction with several other medications to treat lupus and SLE. Therefore, it is important that patients keep all their appointments and take any other medication given, as this will contribute towards the overall success of the treatment.

There are various medical studies that doctors and patients can refer to [ref 2], in order to find out more about the potential impact of belimumab on both lupus, and their overall health. Due to the nature of lupus - being more common in women of certain ethnic groups - there have also been studies into its impact on these groups.

Resources
Last Reviewed:
December 24, 2017
Last Updated:
April 04, 2018
Content Source: