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Kidney Week

Abstract: TH-PO656

The Effect of Voclosporin as Monotherapy in Treating Lupus Nephritis

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Author

  • Nguyen, Thu L., The University of Texas Medical Branch at Galveston, Galveston, Texas, United States
Introduction

The current standard of care for lupus nephritis typically involves the use of combination therapy with immunosuppressive medications, such as mycophenolate mofetil (MMF) or cyclophosphamide, along with low-dose corticosteroids. While these medications can be effective in treating lupus nephritis, they are also associated with a range of potential side effects. We present a case of a young female patient who had multiple recurrent infections while on MMF which prompted conversion to voclosporin monotherapy with success in maintaining complete remission.

Case Description

We present a case of a 21 year old African American female with a past medical history of systemic lupus erythematosus (SLE), diagnosed at the age of 18, complicated by lupus nephritis (LN) class III. The patient was initially treated with a combination of mycophenolate mofetil (MMF), low-dose corticosteroids and hydroxychloroquine. Despite achieving partial remission with this treatment, the dose of MMF had to be reduced due to recurrent infections and persistent leukopenia. Voclosporin was eventually added to the regimen with the aim of achieving complete remission. However, MMF was eventually discontinued as the patient continued to have complications. The patient was continued on voclosporin monotherapy with low-dose prednisone for a total of 12 months, during which she achieved complete remission of her LN, with a stable serum creatinine and undetectable proteinuria.

Discussion

Lupus nephritis is a serious complication of SLE, and its treatment often requires the use of immunosuppressive medications, such as MMF and cyclophosphamide which bring with them a wide range of side effects including infections and myelosuppression. Voclosporin is a novel calcineurin inhibitor that has shown promise as a potential treatment for LN. It has been shown to be effective and well-tolerated in combination with MMF and low-dose corticosteroids in the AURA-LV and Aurora 1 trials. This case report demonstrates that voclosporin monotherapy may be an effective and safe treatment option for LN along with low-dose prednisone for LN in patients who are unable to tolerate or have contraindications to other immunosuppressive medications.