B-cell depletion or belimumab or voclosporin for lupus nephritis?

Curr Opin Nephrol Hypertens. 2021 Mar 1;30(2):237-244. doi: 10.1097/MNH.0000000000000662.

Abstract

Purpose of review: Despite ground-breaking innovations for most autoimmune diseases, the treatment of lupus nephritis has remained largely the same for decades because none of the tested drugs demonstrated superiority over standard-of-care in randomized controlled clinical trials.

Recent findings: Recently, the Belimumab in Subjects with Systemic Lupus Erythematosus - Lupus Nephritis trial tested belimumab, an inhibitor of B-cell activating factor, as an add-on therapy to steroids and either mycophenolate mofetil (MMF) or cyclophosphamide when given IV monthly over a period of 104 weeks at an effect size of 11% for a Primary Efficacy Renal Response. The NOBILITY trial reported positive results for the B-cell-depleting agent obinutuzumab as an add-on therapy to steroids and MMF when given IV every 6 months over a period of 76 weeks at an effect size of 22% for a complete renal response (CRR). The AURORA trial reported positive results for the calcineurin inhibitor voclosporin as an oral add-on therapy to low dose steroids and MMF when given twice daily over a period of 52 weeks at an effect size of 18.5% for a CRR.

Summary: These studies will change the treatment landscape of lupus nephritis. In which way is discussed in this article.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antibodies, Monoclonal, Humanized
  • B-Lymphocytes
  • Cyclosporine
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Lupus Nephritis* / drug therapy
  • Treatment Outcome

Substances

  • Antibodies, Monoclonal, Humanized
  • Immunosuppressive Agents
  • voclosporin
  • belimumab
  • Cyclosporine