What do you feel are the potential barriers to widespread use of obinutuzumab in proliferative lupus nephritis?

1. Insurance Coverage: Oh, easy one! Since it is not FDA-approved yet for lupus nephritis (I bet it will be though... great data so far), insurance will unlikely cover it, except for a few (like Tricare, which is sometimes easier to get off-label drugs).

I am fortunate to have the NIH Lupus Center close by, and they have gotten some of my patients on obinutuzumab. By the way, it also works great on extra-renal SLE!

2. Very poor response to vaccines with B-cell depletors: Another barrier is COVID...

Approximately 50% of the time in my clinical practice, when prescribing Obinutuzumab, insurance companies prefer to cover Rituximab or its biosimilars instead. With the latest data from the REGENCY trial, I am now more hesitant to use Obinutuzumab due to the higher risk of infections—primarily COVID-19—compared to the other two available combination therapies (MMF + Belimumab or MMF + Voclosporin).

I am currently reserving CD20-depleting agents for more refractory lupus nephritis cases. I also fi...