Do you choose rituximab or calcineurin inhibitors for patients with class IV/V lupus nephritis who are refractory to standard of care therapies?

In severe active lupus nephritis, I use rituximab for refractory cases although tacrolimus is an option with published data for induction of lupus nephritis. There have been some instances where I have used both medications together.

Things to keep in mind when making this decision include the profile of the renal biopsy (extent of interstitial damage), patient compliance, accessibility to an infusion center, and pregnancy status.