What are Antinuclear Antibodies (ANA)?

Before jumping to antinuclear antibodies, we will start with antibodies. Antibodies are proteins made by your immune system that help your body recognize and fight harmful substances, such as bacteria and viruses, by activating the immune system to target them. You can think of antibodies as the soldiers that protect your body from bad, foreign invaders.

Sometimes, antibodies mistakenly attack healthy cells and tissues in the body. This is known as an autoimmune response. Antibodies that target healthy proteins specifically in the nucleus of your cells are called antinuclear antibodies (ANA). To continue the analogy from above, ANAs are rogue soldiers that misidentify the cells they are supposed to ignore, and attack them in error.

NOTE: Most people have some ANA, but having too many of these proteins puts you at an increased risk for developing an autoimmune disease, such as lupus.

Who Gets ANA Tests?

Typically, an ANA test is ordered when someone has symptoms that may indicate a systemic autoimmune disease. Some examples of symptoms that may prompt a doctor to order the test include (but are not limited to):

• low-grade fevers
• arthritis-like pain
• fatigue
• weakness
• headaches
• rashes
• muscle pain

Even with a positive ANA test result, it is not clear that a person has lupus. A study published in 2003 in the New England Journal of Medicine found that 88% of people (115 out of 130) eventually diagnosed with lupus had received a positive autoantibody lab result multiple years prior to the diagnosis. On average, that positive test result occurred 3.3 years before the diagnosis was confirmed.

Quick Stats on ANA Tests and Lupus

• 97% of people with lupus will have a positive ANA test.
• Between 5-20% of the general population will have a positive ANA test. A positive test can be a false-positive, or indicate other conditions, such as thyroid disease, certain liver conditions, or other autoimmune diseases.

What Should I Know About ANA Tests and Lupus?

• There is no one definitive test for lupus – an ANA test is just one tool used to help diagnose lupus.
• The ANA test is not a specific test for lupus. This means that most people with lupus will have a positive ANA test, but not everyone with a positive ANA test has lupus.
• Some medications can produce a positive ANA test, so be sure to tell your doctor about any prescription or over-the-counter drugs you take.
• Test results can fluctuate over time and when they are performed at different labs. However, if you have active lupus, your ANA test will probably be positive at most labs, most of the time.

How is an ANA Test Performed?

• An ANA test is performed in a laboratory, using a sample of your blood.
• The test shows if your immune system is producing antinuclear antibodies. A positive ANA test means antinuclear antibodies are present.
• The most common strategies used for detecting and measuring ANAs are indirect immunofluorescence and enzyme-linked immunosorbent assay (ELISA).

What Should I Do if My ANA Test is Positive?

• Your doctor will interpret your ANA test in the context of your symptoms, other lab work, and your medical history, including family history. Keeping a symptom journal or using digital tools can help you be better prepared to go over your symptoms with your doctor.
• Remember, a single positive ANA does not mean you have an autoimmune disease. And a positive ANA test does not require immediate treatment. Your lupus treatment team will take the ANA test results in context with many other factors.

 Benlysta…

• is given to adults with SLE who are receiving other Lupus medicines.
• works by reducing certain cells in your immune system that can make Lupus active.
• targets specific immune cells in your body, rather than the blanket approach of other therapies that suppress your entire immune system.
• is a biological therapy. Biological therapy involves the use of living organisms or substances derived from living organisms to treat disease.
• is a monoclonal antibody. A monoclonal antibody is a type of protein made in a laboratory that finds and attaches to only one type of substance in the body. It is made to target and destroy only certain cells in the body, which may help protect healthy cells from damage.

Before the development of Benlysta, most treatments (such as steroids, antimalarial medications, immunosupressive drugs, and organ-rejection drugs) were borrowed from treatment for other diseases or conditions.

Type: Biologic infusion

Benlysta is given through IV infusion, meaning it is delivered through a needle placed in a vein by a nurse or health provider. The medicine must be given slowly, so the needle will remain in place for at least 1 hour. Preparation time before the infusion and monitoring time afterwards will vary, depending on what your healthcare professional thinks is best for you.

Your doctor will prescribe a dose and schedule that is appropriate for your Lupus symptoms and your body. The most common schedule is to receive the first three infusions at two week increments, and after that to receive one infusion every four weeks.

Benlysta is a biologic, also known as a biopharmaceutical. These types of medications are synthesized from biological sources and can contain sugars, proteins, nucleic acids, or other living cells.

Take a 2 minute survey and help Lupus Warriors better understand the medications that they are taking!

Need-to-know Benlysta Info

Before you begin taking Benlysta, you should have an open and honest conversation with your doctor about all aspects of your lupus (if you haven’t already!).

It is not known if Benlysta is safe and effective in people with severe active lupus nephritis or severe active central nervous system lupus, and it has not been studied in combination with other biologics or intravenous cyclophosphamide. Use of Benlysta is not recommended in these situations.

Do not receive Benlysta if you are allergic to belimumab or to any of the ingredients in Benlysta.

Women who are pregnant, may become pregnant, or are breastfeeding should not take Benlysta as it’s not known what effect it may have on an unborn baby or on breastmilk.

The Benlysta label information from the FDA is available here.

Side Effects of Benlysta

Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Anxiety, depression, thoughts of hurting yourself
• Change in how much or how often you urinate, bloody or cloudy urine, pain or burning when you urinate
• Chest pain or trouble breathing
• Confusion, memory loss, problems with vision, speech, or walking
• Fever, chills, cough, runny or stuffy nose, sore throat, and body aches
• Lightheadedness, dizziness, or fainting, severe headache
• Pain, itching, burning, swelling, bleeding, or a lump under your skin where the needle is placed

If you notice these less serious side effects, talk with your doctor:

• Diarrhea, nausea
• Trouble sleeping

If you notice other side effects that you think are caused by this medicine, tell your doctor.

The most commonly reported negative reactions with Benlysta are nausea, diarrhea, fever, inflammation of the nose and throat, bronchitis, insomnia, pain in extremity, depression, and migraine.

The FDA label also notes that there were more deaths reported during the clinical trial of those on Benlysta as compared to the placebo groups. In 3 clinical trials, 14 deaths occurred out of 2,133 people enrolled in the trials. 3 deaths occurred in the placebo groups while 11 occurred in the Benlysta groups (which were subdivided based on amount of medication received).

A full list of known side effects can be found here.

Starting Benlysta

Benlysta is administered via intravenous infusion only. Additionally, it must be reconstituted and diluted prior to administration. It should not be administered as an IV push or as a bolus.

Benlysta is delivered as a lyophilized powder and needs to be reconstituted, diluted, and administered by a healthcare professional. For those interested, the directions for that process are available on the FDA label.

The dosage schedule for Benlysta traditionally is:

First 3 doses: 10 mg/kg given every 2 weeks

Subsequent doses: 10 mg/kg given ever 4 weeks

All doses should be administered over the course of roughly an hour, though the infusion rate may be slowed or stopped if there are any reactions.

Drug interactions with Benlysta

A total of 109 drugs are known to interact with methotrexate, including 29 major drug interactions. For a full list that can be easily searched, visit drugs.com

Due to the nature of the medication, the weakened immune system may lead to increased incidence of infection. This also means that many live vaccines have an opportunity to interact with the medication and should be discussed with a doctor. This includes:

• the flu vaccine (administered via mist or shot)
• measles vaccine
• mumps vaccine
• polio virus vaccine
• rotavirus vaccine
• rubella vaccine
• smallpox vaccine
• typhoid vaccine

With regard to medications, there are a number of relatively common medications that people with lupus and other autoimmune diseases should be aware of. The following medications are known to interact strongly with Benlysta (tell you doctor if you are taking, or have taken, any of the following):

• Cimzia (certolizumab)
• Enbrel (etanercept)
• Humira (adalimumab)
• Remicade (infliximab)
• Renflexis (infliximab)

Cost

Benlysta is an expensive medication and is not always covered by insurance.

GoodRx makes the following price estimate for 400 mg of Benlysta:

1 400mg vial costs $1,707.

Lupus and Benlysta research

Benlysta was developed and researched specifically for people with lupus.

The initial clinical trials were able to pool the data for the trial groups because there were no differences in safety at various dosing strengths. Participants received either Benlysta or a placebo as an addition to their standard care.

The population in the initial trial was:

• Average age: 39 years old
• 94% Female
• 52% Caucasian

93% of people in the Benlysta groups experienced an adverse reaction compared to 92% of people in the placebo group. The most common adverse reaction was a serious infection (6% in the Benlysta group compared to 5.2% in the placebo group).

3 clinical trials were used to test for the efficacy of the medication. The first helped researchers define a subpopulation, with a positive autoantibody result for whom the medication could be effective. Future studies limited enrollment to those with positive autoantibody scores and SELENA-SLEDAI scored greater than or equal to 6.

The primary endpoint (necessary measure to equal a successful trial) was a decrease of the SELENA-SLEDAI score of greater than or equal to 4 points. A significantly greater number of people in the Benlysta cohort saw this decrease in disease activity as compared to the placebo group for people taking the 10 mg/kg dose of Benlysta.

There was not a significant difference between the placebo group and the Benlysta cohort at the 76 week mark.

Due to lack of diversity and some variable scores, there are still outstanding questions about the efficacy of Benlysta for black or African-American people with lupus. Additional studies are underway to explore any variability in dosing or effectiveness. The FDA label notes that caution should be used when considering Benlysta as a treatment.

Additionally, the researchers noted that taking Benlysta did not significantly reduce a person’s chance of having a severe flare OR enable a person to take significantly less steroids.