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

For a patient with pure Class V lupus nephritis and normal GFR, I’ve used voclosporin + MMF in the past. In this case, the patient is compliant and has been on the combination for almost 1 year with improvement in proteinuria from 12g to 4.2g. We repeated the biopsy, and the patient has similar features to his initial biopsy: pure Class V with severe podocyte effacement. We are planning to change to obinutuzumab, but since he has had partial response to voclosporin, would you consider combining?

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Would you combine obinutuzumab with voclosporin in a patient with class V lupus nephritis?

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Rheumatology · Uniformed Services University of the Health Sciences (USUHS)

Answered on

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 pa...

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Nephrology · The Ohio State University Wexner Medical Center

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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 prospect...

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Rheumatology · Feinstein Institutes for Medical Research

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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.

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Rheumatology · SUNY Upstate Medical University

Answered on

I would just swtch to obinutuzumab.

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