Trials Demonstrate Advances in Lupus Nephritis Treatment

Three recent clinical trials of new treatments for lupus nephritis (LN) have shown positive results, demonstrating superiority of standard of care, according to a recent review.

A recent LN trial—the Belimumab in Subjects with Systemic Lupus Erythematosus—tested belimumab as an add-on therapy to steroids and either mycophenolate mofetil (MMF) or cyclophosphamide, administered intravenously on a monthly schedule. The trial was conducted over a period of 104 weeks, with an effect size of 11% for a primary efficacy renal response.

Results supporting the use of a B-cell depletion agent as an add-on therapy to steroids and MMF were seen in the NOBILITY trial, reporting positive effects of obinutuzumab combined with steroids and MMF when given by IV every 6 months over 76 weeks. The trial resulted in an effect size of 22% for a complete renal response (CRR).

Similarly, the AURORA trial also reported positive results when trialing voclosporin, a calcineurin inhibitor, as oral add-on LN therapy alongside low-dose steroids and MMF. Voclosporin was administered twice-daily over a period of 52 weeks with an effect size of 18.5% for a CRR.

“Despite ground-breaking innovations for most autoimmune diseases, the treatment of lupus nephritis has remained largely the same for decades because none of the tested drugs demonstrated superiority over standard-of-care in randomized controlled clinical trials,” the authors wrote. “These studies will change the treatment landscape of lupus nephritis.”

-Angelique Platas

Reference:

Lei Y, Loutan J, Anders HJ. B-cell depletion or belimumab or voclosporin for lupus nephritis?. Curr Opin Nephrol Hypertens. Published March 1, 2021 doi:10.1097/MNH.0000000000000662