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Abstract: FR-PO643

Trends in Lupus Nephritis: The Co-Management Conundrum

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Rex, Ryan, Spherix Global Insights, Exton, Pennsylvania, United States
  • Foy, Denise, Spherix Global Insights, Exton, Pennsylvania, United States
Background

With new lupus nephritis (LN) treatment options available, patient management is more complex and co-management between nephrologists and rheumatologists presents challenges.

Methods

Nephrologists (n=50) and Rheumatologists (n=50) have been surveyed monthly beginning in Feb. 2021 regarding their use of belimumab and voclosporin in LN. Between Aug. 30 and Oct. 30, 2021, we conducted a retrospective, HIPAA-compliant chart audit (n=954 charts for pts with Class III, IV +/-V LN) in collaboration with 92 nephrologists and 110 rheumatologists.

Results

Longitudinal tracking of voclosporin and belimumab highlight increased rate of initiation and utilization among rheumatologists and nephrologists for both agents, however notable differences are emerging. Additionally, a potential gap in care is noted as 65% of nephrologists and 72% of rheumatologists agree “Co-management between rheumatologists and nephrologists for patients with LN could be vastly improved.”
As of May 2022, the percent of physicians prescribing voclosporin is higher among nephrologists than rheumatologists (52% vs. 40%), however, patient initiations by rheumatologists are beginning to outpace those by nephrologists.

While both groups used calcineurin inhibitors (CNIs) in about 10% of patients in the chart audit, rheumatologists were more likely to use voclosporin than nephrologists who reported higher use of traditional CNIs (Figure 1 uploaded)
Rheumatologists have decades-long experience using belimumab in SLE which translates to greater experience in LN for rheumatologists vs. nephrologists (92% vs. 74%). Rheumatologists report managing over three times as many LN patients on belimumab to date (9.4 vs. 2.6). Further, nephrologists report more than half of their patients on belimumab were initiated by the rheumatologist whereas the converse tends not to occur.

Conclusion

Our data suggests rheumatologists are taking increased ownership of treatment initiation and LN patient management. In addition to vast experience with belimumab in SLE, rheumatologists’ experience with biologic agents and in-office administration helps them navigate the prior authorization process. It is likely rheumatologists will refer patients to nephrologists later than in the past now that new treatment options are available.