Inhibition of B cell activating factor (BAFF) in the management of systemic lupus erythematosus (SLE)

Introduction: The anti-BAFF monoclonal antibody, belimumab, was approved 5+ years ago by the US Food and Drug Administration for the treatment of adult SLE patients. Although BAFF is now a proven therapeutic target in SLE, the limited clinical efficacy both in the clinical trials setting and in real-life' experience begs for further therapeutic improvement.Areas covered: In addition to belimumab, three other BAFF antagonists (atacicept, blisibimod, tabalumab) that biologically differ from belimumab are being or have been evaluated in SLE late-stage clinical trials. Literature search was performed using the search words/phrases, BAFF', BLyS', APRIL', BCMA', TACI', BR3', belimumab', atacicept', blisibimod', tabalumab', lupus clinical trial' along with papers from the author's personal library.Expert commentary: The reasons underlying current lack of enthusiasm among clinicians for BAFF antagonism are discussed, and speculation if offered regarding the use of a BAFF antagonist as part of sequential therapy and regarding the utility of individual or pairs of BAFF receptors as therapeutic targets.