Belimumab
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Trade Name
Benlysta (primary brand name); generic belimumab
Classification
Monoclonal antibody; B-lymphocyte stimulator (BLyS) inhibitor; immunosuppressant
Dosage/Route
- * Dosage:
- – IV: 120 mg or 400 mg vials (powder for reconstitution).
- – Subcutaneous (SC): 200 mg/mL prefilled autoinjector or syringe.
- * Route: Intravenous (IV) infusion; subcutaneous (SC) injection
Usual Dosage
- * IV (Adults): 10 mg/kg IV every 2 weeks for 3 doses, then every 4 weeks.
- * SC (Adults): 200 mg SC once weekly (after IV loading optional).
- * Not approved for children; dose based on weight for IV
Mechanism of Action
Binds to soluble B-lymphocyte stimulator (BLyS), inhibiting its activity. This reduces B-cell survival and differentiation into autoantibody-producing plasma cells, decreasing autoimmune activity (e.g., in lupus)
Side Effects & Adverse Effects
- * Side Effects: Nausea, diarrhea, fever, insomnia, infusion/injection site reactions
- * Adverse Effects:
- – Infections (serious, e.g., pneumonia, UTI due to immunosuppression)
- – Hypersensitivity (anaphylaxis, rash; boxed warning for IV)
- – Depression/suicidality (psychiatric risk)
- – Progressive multifocal leukoencephalopathy (PML) (rare, fatal)
Nursing Management (Implications & Teachings)
- * Implications:
- – Monitor for infection signs (fever, cough) and mental status (depression)
- – IV: Premedicate (antihistamine, acetaminophen) if reaction risk; infuse over 1 hour (diluted in 250 mL NS)
- – SC: Teach self-injection (thigh, abdomen); rotate sites
- – Assess baseline labs (e.g., CBC, IgG) for immunosuppression risk
- * Teachings:
- – Report fever, swelling, or mood changes immediately
- – Avoid live vaccines during treatment
- – Store SC in fridge; warm to room temp 30 min before use
- – Expect fatigue; plan rest after IV doses
Indication for This Patient
- * Systemic Lupus Erythematosus (SLE): Active, autoantibody-positive, in adults/children ≥5 (IV) or adults (SC), as adjunct to standard therapy
- * Lupus Nephritis: Active, in adults (with SLE)
Time
- * Timing:
- – IV: Every 2 weeks (first 3 doses), then every 4 weeks.
- – SC: Once weekly.
- * Infusion Time: IV over 1 hour.
- * Onset: Symptom improvement in weeks; full effect in months
