In the treatment of lupus nephritis, which patients may benefit from the use of rituximab or other B-cell depleting agents during induction?

I agree with @Dr. @Dr. First Last's previous answer (posted July 2020). In addition, the 2024 ACR Lupus Nephritis guidelines (discussed at the 2024 ACR meeting) still recommend mycophenolate (MMF) or cyclophosphamide as first-line induction therapies for lupus nephritis (LN), rather than B-cell depletion. Adjunctive therapies like Belimumab and Voclosporin have shown promise in improving treatment efficacy, and some experts advocate for a "triple therapy" approach with MMF, Belimumab, and Voclos...

B-cell directed therapies with or without a standard of care (SoC) are not regarded as first-line therapies for lupus nephritis. Following the case series of successful treatments of lupus nephritis with rituximab, the LUNAR study showed that rituximab+SoC improved immunologic parameters but not clinical outcomes when compared to SoC. In an interesting case series though, Rituximab+mycophenolate (rituxilup protocol) showed impressive effectiveness avoiding the use of steroids other than 2 infusi...