Voclosporin for the treatment of lupus nephritis flares in patients with inadequate response to mycophenolate mofetil and belimumab: a case series.
Riccardo Bertola, Ettore Silvagni, Laura Scichilone et al.
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Case in brief
This case series describes three patients with lupus nephritis (LN) flares and nephrotic-range proteinuria despite treatment with mycophenolate mofetil and belimumab. One patient developed acute kidney injury and worsening proteinuria while receiving both drugs; another had a nephrotic flare after an infection with insufficient response to the combination; and a third flared shortly after starting belimumab. After voclosporin was introduced, LN relapses were controlled in all three cases. Treatment was generally well tolerated, with no clinically relevant adverse events reported.
What made this case unusual
The series highlights nephrotic LN flares occurring despite mycophenolate–belimumab therapy, including one shortly after belimumab initiation, and reports control of all three relapses with voclosporin.
Diagnostic / clinical pearl
In these cases, persistent or recurrent nephrotic-range proteinuria despite mycophenolate and belimumab prompted use of voclosporin, with reported control of the LN flares.
Why it matters
The cases add clinical experience with voclosporin for relapsing nephrotic LN, while the optimal use and timing of these agents in relapsing disease remain unsettled.