Would you use voclosporin or belimumab as adjunctive therapy for treatment of lupus nephritis?
Yes, I would. However, this is not a uniformly accepted practice. Many clinicians believe the effect sizes were not sufficiently large to warrant drugs as initial therapy. The reasons for dual therapy (MMF and belimumab or MMF and voclosporin) go beyond the primary endpoint of the BLISS-LN and Auror...
I do not consider voclosporin (VOC) or belimumab (BEL) adjunctive therapies for lupus nephritis (LN). I consider them both important first-line therapies for most proliferative LN patients.
In the past 2 decades, numerous lupus nephritis clinical trials failed, not meeting their primary endpoints (a...
It is too early to say exactly how the treatment of lupus nephritis will change in practice.
The combination of voclosporin-MMF seems to increase the overall response rate significantly from the 20s to the 40s. One of the main advantages of the voclosporinMMF combination regimen is that significant ...
I believe we need to address the elephant in the room which is adherence. Belimumab is a weekly SC injection or a monthly infusion, both of which are more palatable to my young LN patients rather than voclosporin which is 3 tablets twice a day. The extra pill burden, added to baseline mycophenolate ...
The timing of your question couldn't be more perfect, @Dr. First Last! It is the topic of tomorrow's Great Debate at ACR Convergence with pro-belimumab presented by Dr. Michelle Petri and pro-voclosporin presented by Dr. @Dr. First Last. There are situations when I would choose one over the other (o...
When considering therapy for lupus nephritis, both voclosporin and belimumab are viable options and are endorsed by KDIGO Glomerular disease guidelines.
Voclosporin
Voclosporin is a calcineurin inhibitor that together with mycophenolate mofetil (MMF) and low dose corticosteroids led to a superior comp...
It is important to remember that there is to date no conclusive evidence of the efficacy of adding either Voclosporin or Belilumab in patients with lupus nephritis where the background treatment is cyclophosphamide as opposed to mycophenolate.
In the AURORA trial with Voclosporin, the background ther...