Effect of induction therapy with mycophenolate or cyclophosphamide on serum BAFF levels in patients with systemic lupus erythematosus

Abstract

Introduction

Systemic lupus erythematosus (SLE) is a complex autoimmune disease in which B cell hyperactivity plays a key role in its pathophysiology. In this disease, the B cell activating factor (BAFF) is implicated in the loss of immunological tolerance, and high concentrations of this factor have been linked to disease progression. It is unknown how induction therapies with cyclophosphamide (CFM) or mycophenolate (MMF) modulate BAFF levels.

Objective

To determine how induction therapies modulate BAFF concentrations.

Materials and methods

An analytical observational study was performed with 20 patients with SLE from two institutions between 2020–2022, clinical and laboratory information was obtained from medical records. Measurement of serum BAFF levels was performed using an ELISA kit and statistical analyses with GraphPad Prism version 9.

Results

20 patients with a diagnosis of SLE, 18 with CFM and 2 with MMF, were included, nine patients at baseline and eleven at 3–6 months. The median BAFF in SLE patients was 902.2 pg/mL and 379.7 pg/mL in healthy controls, statistically significant differences (p = .0003). BAFF levels were also found to be different among patients treated with antimalarials (p = .0465) and an inverse correlation with creatinine values and prednisolone doses was also observed.

Conclusions

BAFF levels are affected during induction therapy, observing an initial reduction and subsequent recovery at 3–6 months, our results suggest that chloroquine and high doses of prednisolone maintain lower serum BAFF levels.