Beyond systemic lupus erythematosus: a systematic review on the use of belimumab in other connective tissue diseases and vasculitides

TL;DR

This paper reviews the potential use of belimumab, a drug known for treating lupus, in other rheumatic diseases and finds it may help some patients with overactive B cells.

Contribution

The study systematically reviews and evaluates the current evidence for belimumab's use in non-SLE rheumatic conditions.

Findings

Belimumab's role in rheumatic diseases beyond SLE is not well established due to limited data.

Belimumab may be effective in patients with rheumatic diseases involving abnormal B cell activation.

More large-scale trials are needed to confirm belimumab's efficacy in these conditions.

Abstract

Belimumab is a monoclonal antibody with proven efficacy in systemic lupus erythematosus. However, its role in other connective tissue diseases or vasculitides is still not clear.

A systematic literature review (SLR) of original research article up to March 22 2025 was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were selected according to the Patients Exposure Outcome (PEO) framework and evaluated by quality assessment of diagnostic accuracy studies (QUADAS).

Thirty-seven articles were identified as relevant and assessed for eligibility. After full evaluation, 15 articles were selected to be included in the review.

The SLR showed that data on the use of belimumab in rheumatic conditions, other than SLE, are still scarce. However, belimumab may have therapeutic potential in specific subsets of patients with rheumatic diseases characterized by aberrant B cell activation. Future research should focus on large, randomized phase 3 trials with extended follow-up to better define the role of belimumab in rheumatic diseases beyond SLE, particularly in combination with standard-of-care therapies.

The online version contains supplementary material available at 10.1007/s10067-025-07847-5.

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