Concurrent Use of Anifrolumab and Belimumab in a Patient With Systemic Lupus Erythematosus Presenting With Recurrent Severe Cutaneous Involvement and Lupus Nephritis.

Anifrolumab and belimumab are two biologic agents extensively employed in patients with systemic lupus erythematosus (SLE). Anifrolumab has demonstrated pronounced efficacy in reducing cutaneous inflammatory activity in cases refractory to other therapies. Belimumab has exhibited clinical effectiveness in ameliorating articular symptoms and renal involvement, as well as in decreasing the occurrence of new disease flares. The case presented here constitutes a singular report in the literature owing to the combined use of both biologic therapies. The patient initially developed intense inflammatory facial lesions, which responded completely to anifrolumab. Thereafter, lupus nephritis developed and was managed with belimumab following cessation of anifrolumab, leading to improvement in renal parameters. Upon reactivation of cutaneous lesions, anifrolumab was reinstated concomitantly with belimumab, resulting in full resolution of the skin lesions while preserving complete remission of the lupus nephritis. We discuss how various biologic agents can act on separate pathogenic pathways contributing to organ involvement in SLE. We suggest that in some cases with severe cutaneous and renal involvement that do not respond to anifrolumab and belimumab individually, the agents may be used in combination to achieve adequate control of lupus disease.