Patients with 4 or more criteria for SLE according to the American College of Rheumatology (ACR) 1997 criteria or SLICC 2012 criteria or biopsy proven lupus nephritis with one additional supportive test on at least two occasions (positive ANA, anti-dsDNA antibodies or anti-Sm antibodies)
History of anti-dsDNA antibodies detectable at least once in the past 5 years prior to screening the patient on the study protocol (ELISA test should be used for Anti dsDNA antibody testing)
Patients have received the first infusion of this cycle of B cell depletion therapy (Rituximab) 4-8 weeks before randomisation. Previous use of Rituximab is allowed prior to this cycle
No contraindications to the use of Belimumab
Ability to provide informed consent
Severe “critical” SLE flare defined as BILAG A flare in CNS system or any SLE manifestation requiring more immunosuppression than allowed within the protocol in the physician’s opinion
Pregnancy and/or Breast Feeding patients
At risk of pregnancy and unwilling to use an acceptable form of birth control contraception
Prior use of Belimumab, Atacicept or any biologic therapy (except Rituximab, but no other B cell depleting therapies)
Participation in any other interventional trial within the last 6 months
eGFR <30mls/min at screening
Active infections, including but not limited to:
i. Current or past infection with hepatitis B or C as defined by: A. Hepatitis B surface antigen positive B. Hepatitis B surface antibody positive and hepatitis B core antibody positive C. Hepatitis C antibody positive
ii. Historically positive HIV test or test positive at screening for HIV
iii. Active TB.
i. Currently on any suppressive therapy for a chronic infection (such as tuberculosis, pneumocystis, cytomegalovirus, herpes simplex virus, herpes zoster and atypical mycobacteria)
ii. Hospitalisation for treatment of infection within 60 days of Day 0
iii. Use of parenteral (IV or IM) antibiotics (antibacterials, antivirals, anti-fungals, or anti-parasitic agents) within 30 days of Day 0
Receipt of a live-attenuated vaccine within 3 months of Day 0 (see participant timeline)
In the investigator’s opinion, patients that are at high risk for infection (including but not limited to in dwelling catheter, dysphagia with aspiration, decubitus ulcer, history of prior aspiration pneumonia or recurrent severe urinary tract infection)
IgG levels below 4.0 g/L, IgA level < 10 mg/dL (IgG and IgA test must be performed no more than 10 days before study drug commenced for the second inclusion/exclusion criteria assessment at day 0)
History of malignant neoplasm within the last 5 years
History of cervical dysplasia CIN Grade III cervical high risk human papillomavirus or abnormal cervical cytology other than abnormal squamous cells of undetermined significance (ASCUS) within the past 3 years. The patient will be eligible after the condition has resolved (e.g., follow- up HPV test is negative or cervical abnormality has been effectively treated >1 year ago)
Severe, progressive, or uncontrolled renal, hepatic, haematological, gastrointestinal, pulmonary, cardiac, or neurological disease or, in the investigator’s opinion, any other concomitant medical condition or significant abnormal laboratory value that places the participant at risk by participating in this study with the exception of diseases or conditions related to active SLE
Comorbidities currently requiring systemic corticosteroid therapy.
Evidence of serious suicide risk including any history of suicidal behaviour in the last 6 months and/or any suicidal ideation in the last 2 months or who in the investigator’s judgement, pose a significant risk
History of an anaphylactic reaction to parenteral administration of contrast agents, human or murine proteins or monoclonal antibodies
Current drug or alcohol abuse or dependence, or a history of drug or alcohol abuse or dependence within 364 days prior to Day 0
White blood cells (WBC) <1.5 x 109/L, Neutrophils <1 x 109/L measured up to 10 days before week 0 (study drug commenced)
A history of major organ transplant or hematopoietic stem/cell/marrow transplant or renal transplant.
Contact the Clinical Trial Manager or Data Manager for more information about the BEAT Lupus trial.