How do you determine duration of therapy for patients who have responded well to voclosporin therapy?

Determining the duration of therapy for patients who have responded well to voclosporin therapy in lupus nephritis involves several considerations, including patient-specific factors, disease activity, and risk of relapse. Here is a suggested approach:

The duration of therapy is determined by the ren...

I assess response per the EULAR guidelines (which were extrapolated from trials like the ALMS trial):

• At 3 months, success is at least a 25% reduction in proteinuria and no worsening of renal function.
• At 6 months, success is at least a 50% reduction in proteinuria and no worsening of renal function...

The first order of business is to taper steroids, and hopefully discontinue them. If the patient is doing well, I taper their background immunosuppressive, which is usually MMF. The question, thereafter, is whether to stop the background therapy or taper the second drug. In the case of the combinati...