Biologic therapies in patients with neuropsychiatric systemic lupus erythematosus

Sir, Neuropsychiatric (NP) involvement is a prevalent and often severe feature of systemic lupus erythematosus (SLE). Diverse factors are involved in its aetiopathogenesis and treating this condition is often quite challenging. However, clinical trials of biologic therapies in patients with SLE exclude those with severe NP manifestations. The place for the use of biologic approaches is thus even more problematic than it is for other aspects of SLE. We performed a literature search in Medline, in order to review the evidence for the use of biologic therapies in the treatment of NPSLE, in the last five years. We selected nine studies with rituximab and one with belimumab. Belimumab is currently the only specific targeted drug approved for the treatment of SLE. In a posthoc analysis of the Belimumab in Subjects with Systemic Lupus Erythematosus (BLISS)-52 and BLISS-76 trials, which included 1684 patients with moderately to severely active (Safety of Estrogens in Lupus Erythematosus National AssessmentSystemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) 6) seropositive SLE, the authors have looked for changes in British Isles Lupus Assessment Group (BILAG) and SELENASLEDAI organ domain scores at week 52 of followup. They found 45 patients with central nervous