Would you consider combining voclosporin and obinutuzumab for pure Class V lupus nephritis?

I agree with @Dr. First Last. Changing his regimen is indicated since target proteinuria (<700 mg/day by 1 year) has not been achieved, and renal biopsy shows ongoing active inflammatory class V (very smart to get that biopsy, by the way!).

Obinituzumab (OBI) is the better choice than belimumab in patients with proteinuria >3 g/day (Rovin et al., PMID 34560137). In the phase 3 REGENCY trial (Furie et al., PMID 39927615), OBI was used in combination with mycophenolate mofetil (MMF). I would contin...

As you know, the use of obinutuzumab in pure class V LN was not tested in REGENCY. But we do know that anti-CD20 therapies have been used for class V successfully. In addition, obinutuzumab was effective for patients with class V mixed disease. While I do think obinutuzumab should be tested prospectively for pure V, my own opinion is that it will likely be effective. Taking this one step further, given the significant degree of proteinuria remaining in the described patient, I think the combinat...

Interesting question. Pure class V was not studied in NOBILITY OR REGENCY, nor were voclo and obinutuzumab studied. So, you are on your own. We await the MAJESTY results of idiopathic membranous with obinutuzumab, but that still doesn't answer your question.

I would just swtch to obinutuzumab.