Do you favor obinutuzumab over voclosporin for patients with lupus nephritis and significant proteinuria and a history of non-adherence to medications?

Non-adherence to medications is a common issue in lupus patients, but this can be even more of a concern in lupus nephritis, where the pill burden for patients can be so high. I usually prefer to use intravenous medications for patients who have had difficulty adhering to oral medications in the past. The dosing regimen for obinutuzumab is also appealing for patients: 1000 mg IV infusion at weeks 0 and 2, repeated every 6 months. The data from the phase III REGENCY trial also supports the use of obinutuzumab in patients with significant proteinuria; greater differences in the percentages of patients who had a complete renal response were seen in subgroups with baseline features indicative of high disease activity, such as a urinary protein-...