2021 PANLAR: Experts are still controversial about the new drug for lupus nephritis combined with immunosuppressive agents

Lupus nephritis is a kidney disease secondary to systemic lupus erythematosus
.

Since June 2021, two new drugs for the treatment of lupus nephritis (Voclosporin and Belimumab) have been approved for marketing by the US Food and Drug Administration
.

These new interventions are exciting and mean that the above-mentioned drugs can be combined with immunosuppressive agents to jointly treat lupus nephritis
.

Voclosporin August 2021, at the 2021 Pan American Rheumatism Association Conference (PANLAR), Ohio State University Nephrology Professor Brad Rovin believes that based on the data from the Phase 3 trial of Voclosporin, Voclosporin can reduce the level of urine protein in patients
.

He believes that this effect is based on Voclosporin's mechanism of blocking calcineurin, which can protect synaptic topoproteins, which is beneficial to podocytes
.

Many evidences indicate that podocytes are the cells that protect the kidney, and the death of podocytes can lead to glomerular sclerosis and decreased renal function
.

 At the same time, Professor Brad Rovin reiterated that Voclosporin may also have other mechanisms to protect the kidneys, but more experiments are needed to reveal them
.

Voclosporin may be combined with immunosuppressive agents, and patients with lupus nephritis may benefit from this
.

BelimumabBelimumab is also very effective
.

Trials have shown that in the Belimumab group, 16% of patients had a kidney-related event or death within 2 years, compared with 28% in the placebo group
.

Patients in the Belimumab group are more likely to achieve a renal remission rate of 50%
.

Renal response rate of 50% is defined as urine protein-creatinine ratio ≤0.
7; the estimated glomerular filtration rate (eGFR) decline rate from baseline does not exceed 20% or ≥60ml/min/1.
73㎡, and first aid measures are not used
.

 Richard A.
Furie, director of the Department of Rheumatology at Northwell Health Center, commented: "This trial is very strict because it included patients with type V lupus nephritis
.

" As we all know, type V lupus nephritis is more difficult.
Therapeutic
.

He believes that Belimumab will help clinical patients
.

Different voices However, the host of the conference, Graciela Alarcon, professor emeritus of medicine at the University of Alabama at Birmingham, believes that there is no direct clinical comparison of these two new drugs, and which new drug combined with immunosuppressive agents will be more beneficial to patients.
More data is needed
.

In fact, for some patients, combination therapy may mean over-treatment
.

 It is worth noting that Professor Graciela Alarcon proposed that many physicians use only one drug (such as mycophenolate mofetil) when treating lupus nephritis; and more physicians may find that mycophenolate mofetil is ineffective or very effective for patients.
After micro, choose the second drug for combination or dressing
.

 Participants agreed that even if patients use drug combination therapy, the response rate is still unsatisfactory, about 30%-40%
.

 Finally, Professor Brad Rovin proposed a possibility that Belimumab can be combined with Voclosporin to increase the response rate of patients with lupus nephritis
.

 Related reading Phase 1.
3 clinical trials revealed that the new drug Voclosporin for lupus nephritis has good efficacy and safety; 2.
AURORA 2: Voclosporin can maintain the reduction of proteinuria in patients with lupus nephritis for 2 years
.

References: 1.
Thomas R.
Collins.
Experts Debate Merits of Dual Therapy for Lupus Nephritis.
August 19, 2021.
2.
Pan American League of Associations for Rheumatology (PANLAR) 2021 Annual Meeting: Presented August 15, 2021.