Belimumab

INTRODUCTION

Indications

Treatment of active autoantibody-positive systemic lupus erythematosus (SLE) in patients currently receiving standard therapy.

Action

A monoclonal antibody produced by recombinant DNA technique that specifically binds to B-lymphocyte stimulator protein (BLyS), thereby inactivating it. Therapeutic Effects: ↓ survival of B cells, including autoreactive ones and ↓ differentiation into immunoglobulin-producing plasma cells. Result is ↓ disease activity with lessened damage/improvement in mucocutaneous, musculoskeletal, and immunologic manifestations of SLE.

Adverse Reactions/Side Effects

CNS: depression, insomnia, migraine. GI: nausea, diarrhea. GU: cystitis. Hemat: leukopenia. MS: extremity pain. Misc: allergic reactions including ANAPHYLAXIS, INFECTION, infusion reactions, fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria, dermatitis). Be especially alert for responses that occur during and after administration (infusion-related reactions). Notify physician or nursing staff immediately if these reactions occur.

• Be alert for signs of leukopenia and infections, including fever, sore throat, mucosal lesions, chills, nausea, vomiting, diarrhea, and localized inflammation. Notify physician or nursing staff of these signs immediately.

• Periodically assess symptoms of SLE such as joint pain/stiffness, muscle weakness, fatigue, skin lesions (rashes, bruising), Raynaud-like symptoms (decreased circulation to the fingers and toes), and changes in mood and behavior (depression, anxiety, memory deficits). Document whether drug therapy is successful in reducing these symptoms.

• Monitor personality changes, including depression and increased thoughts of suicide. Notify physician if these changes become problematic.

• Assess any extremity pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

Interventions

• Design and implement strengthening activities, cardiac conditioning, and other therapeutic exercises as tolerated to maintain function and complement drug effects in patients with SLE.

Patient/Client-Related Instruction

• Advise patient to guard against infection (frequent hand washing, etc.) and to avoid crowds and contact with persons with contagious diseases.

• Instruct patient to report other troublesome side effects such as prolonged or severe insomnia, migraine headaches, bladder pain/irritation, fever, or GI problems (nausea, diarrhea).

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.

Distribution: Unknown

Metabolism and Excretion: Unknown

Half-life: 19.4 days

Contraindications/Precautions

Contraindicated in:...