Lupus & antiphospholipid syndrome
Real-world experience with belimumab-based triple therapy in proliferative lupus nephritis: data from the BEL-SPAIN Registry
Authors' conclusion
BEL-based triple therapy is effective and safe in proliferative LN, achieving high renal and extrarenal response rates, substantial GC-sparing and treat-to-target outcomes in real-world practice.
Study context
- Population
- Patients with proliferative lupus nephritis (LN) (new-onset or relapsing); mean age 37 years; 85.7% female; 67.3% Caucasian
- Participants
- 49 patients
- Outcome
- Renal response
- Follow-up
- 12 months
Methodological detailsmulticentre, real-world, registry (BEL-SPAIN), Median time from renal flare to belimumab (BEL) initiation 1 month (IQR 0-3)
- Multicentre
- Real-world
- Registry (BEL-SPAIN)
- Median time from renal flare to BEL initiation 1 month (IQR 0-3)
Main finding
As reported in the abstract
Complete renal response (CRR)
67.3%
Primary efficacy renal response (PERR)
75.5%
At least partial renal response
83.7%
Observational data: associations, not effects.
Further findings
| Outcome | Estimate | P value |
|---|---|---|
| CRR and PERR by baseline proteinuria (<3 g/day vs ≥3 g/day)Proteinuria <3 g/day vs Proteinuria ≥3 g/day | CRR rate 78.1% vs 47.1% | P = 0.027 |
| CRR and PERR by baseline proteinuria (<3 g/day vs ≥3 g/day)Proteinuria <3 g/day vs Proteinuria ≥3 g/day | PERR rate 84.4% vs 58.8% | P = 0.048 |
Median proteinuria · 12 months
- Median proteinuria, baseline → follow-up
- 2.7 g/day to 0.49 g/day
- eGFR, mL/min/1.73 m²
- 71 to 78
Mean glucocorticoid (GC) dose · 12 months
- Mean GC dose, baseline → 12 months
- 31.7 mg/day to 3.5 mg/day
- Complete GC withdrawal
- 26.1%
Extrarenal disease activity
- Present at baseline (predominantly articular and mucocutaneous)
- 81.6%
- Clinically meaningful improvement during follow-up
- 80%
Treat-to-target outcomes · 12 months
- DORIS remission
- 40.8%
- Lupus Low Disease Activity State (LLDAS)
- 46.9%
Renal treatment failure and renal relapse
- Renal treatment failure
- 16.3%
- Renal relapse
- 4.1%
Safety
- Serious BEL-related events
- 0
- Adverse events were mild
Original publication
Real-world experience with belimumab-based triple therapy in proliferative lupus nephritis: data from the BEL-SPAIN Registry. Lupus Sci Med. Published 27 January 2026. doi:10.
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