Benlysta (Belimumab): The Weekly Lupus Injection
For many living with lupus, the once-weekly self-administered injection provides a critical advancement in treatment options. The medication responsible is belimumab, marketed under the brand name Benlysta. As a biologic, it represents a more targeted approach to managing this complex autoimmune disease, focusing on the specific overactivity of B cells that contributes to lupus inflammation. The weekly injection formulation was approved by the FDA to provide a convenient at-home option for patients who prefer to avoid regular clinic infusions. This shift has significantly improved the quality of life for many, offering greater independence and flexibility in their treatment schedule.
What is Benlysta and how does it work?
Benlysta is a type of medicine called a monoclonal antibody. Its active ingredient, belimumab, works by binding to and blocking a protein called B-lymphocyte stimulator (BLyS). This BLyS protein is crucial for the survival of B-cells, which produce harmful autoantibodies that attack the body's healthy tissues in lupus. By inhibiting BLyS, Benlysta reduces the survival of these overactive B-cells, leading to a decrease in the autoantibody production that causes inflammation and organ damage. This targeted approach helps to reduce disease activity, prevent flares, and improve symptoms such as joint pain, fatigue, and skin rashes. It is not a steroid and does not suppress the entire immune system in the same way as older treatments.
Who is eligible for the weekly injection?
Benlysta's subcutaneous injection is approved for adults and children (ages 5 and older) with active systemic lupus erythematosus (SLE). It is also approved for treating active lupus nephritis (lupus-related kidney inflammation) in adults and older children. Patients receiving Benlysta typically do so alongside other standard lupus therapies, such as hydroxychloroquine. A healthcare provider will evaluate a patient's condition to determine if they are a suitable candidate for this treatment. It is not recommended for those with severe active central nervous system lupus.
Dosing and Administration
The weekly injection offers a more flexible treatment experience compared to the hospital-based intravenous (IV) infusion. The choice between administration methods depends on the patient's condition, preferences, and the prescribing doctor's recommendation.
Subcutaneous vs. Intravenous Administration
Benlysta can be administered in two ways, each with a different frequency and setting:
- Subcutaneous (SC) Injection: This is the once-weekly, self-administered option. After initial training from a healthcare provider, adults and some children can inject the medication at home using either a pre-filled syringe or an autoinjector. The typical dose for adults with SLE is 200 mg once per week. For lupus nephritis, the dose starts higher for a short period before settling into the weekly maintenance dose.
- Intravenous (IV) Infusion: Administered in a hospital or clinic by a healthcare professional, the IV infusion schedule is less frequent. The first three infusions are given every two weeks, followed by a maintenance infusion every four weeks thereafter.
The self-injection process
Administering the weekly subcutaneous injection is a straightforward process once a healthcare provider has provided training. Key steps include:
- Preparation: Remove the Benlysta autoinjector or pre-filled syringe from the refrigerator about 30 minutes before use to allow it to reach room temperature. Do not attempt to warm it using heat. Visually inspect the solution to ensure it is clear to colorless or pale yellow.
- Injection Site: The injection should be administered into the fatty tissue just under the skin. Common sites include the abdomen (avoiding a 2-inch circle around the navel) and the thigh. It is important to rotate the injection site with each dose to prevent irritation.
- Administration: Follow the specific instructions for the device, whether it is an autoinjector or a pre-filled syringe. Autoinjectors are designed to be user-friendly, administering the dose with the push of a button.
- Disposal: After use, the device should be safely disposed of in a sharps container.
Potential Side Effects and Safety Considerations
While Benlysta is a valuable treatment, it is associated with potential side effects and risks. Patients should discuss these with their healthcare provider before starting treatment.
Common side effects
Reported side effects include:
- Nausea and diarrhea
- Headache
- Pain in arms or legs
- Infections, such as colds, bronchitis, or urinary tract infections (UTIs)
- Injection site reactions, including redness, pain, or swelling
- Fever
Serious risks
Benlysta carries several serious risks, including:
- Serious Infections: Since Benlysta affects the immune system, it can increase the risk of serious and sometimes fatal infections. Patients should be monitored for signs of infection.
- Progressive Multifocal Leukoencephalopathy (PML): This is a rare but serious viral brain infection that can lead to severe disability or death.
- Depression and Suicidality: Reports of new or worsening depression and suicidal thoughts have occurred in patients taking Benlysta. Mental health should be monitored throughout treatment.
- Allergic Reactions: Severe allergic reactions, including anaphylaxis, can occur, especially with IV infusions.
Benlysta Subcutaneous vs. Intravenous Comparison
| Feature | Subcutaneous (Weekly) | Intravenous (Monthly) |
|---|---|---|
| Administration | Self-injection at home (pre-filled syringe or autoinjector) | Infusion at a clinic or hospital by a healthcare professional |
| Frequency | Once per week | Initial doses every 2 weeks (3 doses), then monthly |
| Time Commitment | A few minutes for injection | Approximately 1 hour for the infusion, plus observation time |
| Convenience | High; administered in the privacy of one's home | Lower; requires travel and time at a medical facility |
| Dose | 200 mg (or 400 mg initially for lupus nephritis) | Weight-based dosage (10 mg/kg) |
Conclusion
The weekly self-administered injection of Benlysta (belimumab) represents a significant step forward in personalized lupus care, offering patients a more convenient way to manage their condition from home. By targeting the underlying mechanism of the disease, it helps reduce flares and other debilitating symptoms. However, as with any medication, it comes with potential risks and side effects that must be carefully considered with a healthcare provider. The choice between the subcutaneous injection and the intravenous infusion is a personal one, best made in consultation with a rheumatologist who can evaluate the individual patient's needs and lifestyle. For many, the independence and ease of the once-a-week injection make it a preferred option for long-term lupus management.
Key takeaways
- Benlysta is the once-weekly lupus injection. The medication's generic name is belimumab.
- It is a biologic medicine targeting B-cells. Benlysta works by inhibiting the BLyS protein, which reduces the activity of overactive B-cells responsible for producing harmful autoantibodies in lupus.
- The injection is self-administered at home. After training, patients can use a pre-filled syringe or an autoinjector to give themselves the shot.
- Benlysta also comes as an intravenous infusion. For those who prefer or require it, Benlysta can be administered in a clinic setting on a less frequent basis.
- Eligibility includes SLE and lupus nephritis. The subcutaneous injection is approved for adults and children aged 5 and older with active systemic lupus erythematosus (SLE) or lupus nephritis.
- Awareness of side effects is crucial. Patients should be mindful of common side effects like nausea and headache, as well as more serious risks such as infections and depression.
