Abstract: SA-PO0857
Voclosporin for Induction Treatment of Lupus Nephritis in a Predominantly Black Patient Population: A Case Series
Session Information
- Glomerular Management: Real-World Lessons and Emerging Therapies
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Kim, Paul, Emory University School of Medicine, Atlanta, Georgia, United States
- Ayele, Frehiywot K, Emory University School of Medicine, Atlanta, Georgia, United States
- King, Spencer A., Harbor-UCLA Medical Center, Torrance, California, United States
- Ward, Ivanna, Morehouse School of Medicine, Atlanta, Georgia, United States
- Cobb, Jason, Emory University School of Medicine, Atlanta, Georgia, United States
Background
Voclosporin, a novel calcineurin inhibitor, is the latest FDA-approved treatment for lupus nephritis (LN). Its efficacy and safety were demonstrated in the AURORA-1 trial in combination with mycophenolate mofetil and steroids for induction of lupus nephritis and long-term maintenance in the AURORA-2 trial, showing a 32% complete renal response (CRR) at 24 weeks. However, only 15% of patients in the voclosporin arm were Black, limiting generalizability. We present a case series evaluating voclosporin in an urban, predominantly Black population.
Methods
We retrospectively reviewed electronic medical records of two Emory Hospital sites from 2021–2025 for patients prescribed voclosporin. Inclusion required ≥24 weeks of follow-up, and we looked at CRR, defined as a urine protein-creatinine ratio (UPCR) <0.5 g/g and stable eGFR (>60 ml/min or ≤20% decline from baseline). Safety and tolerability were assessed.
Results
Out of 22 patients, 19 met inclusion criteria with 16 identified Black patients. LN classes were: 7 Class V, 4 Class IV/V, 4 Class III/V, 1 Class II/V, and 3 Class IV. Baseline values: serum creatinine 0.84 mg/dL, eGFR 94.6 ml/min, UPCR 3.88 g/g. At 24 weeks: serum creatinine 1.01 mg/dL, eGFR 88.1 ml/min, UPCR 1.36 g/g, a 64.8% proteinuria reduction. CRR was achieved in 31.6% of patients. Those with nephrotic-range proteinuria had a 78.6% reduction. One patient developed AKI; one had worsening UPCR. Average serum magnesium level of 1.7 mg/dL.
Conclusion
Voclosporin showed comparable efficacy (31.6% CRR) to AURORA-1 (32%) in a population with higher representation of Black patients (84% vs. 15%). Notably, 37% had pure Class V LN, compared to 14% in AURORA-1. Voclosporin was well-tolerated, with only one patient discontinuing therapy. These findings suggest voclosporin may be particularly beneficial for LN patients with nephrotic-range proteinuria and in pure class V. Further evaluation of 52-week outcomes and long-term maintenance is warranted.