Abstract: SA-PO0859
Real-World Use of Voclosporin in Lupus Nephritis
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
- Nhuien, Khoanh Iien, Barts Health NHS Trust, London, England, United Kingdom
- Nadarajah, Luxme, Barts Health NHS Trust, London, England, United Kingdom
- Pakozdi, Angela, Barts Health NHS Trust, London, England, United Kingdom
- Pyne, Dev, Barts Health NHS Trust, London, England, United Kingdom
- Cove-Smith, Andrea, Barts Health NHS Trust, London, England, United Kingdom
- Rajakariar, Ravindra, Barts Health NHS Trust, London, England, United Kingdom
Background
Following the publication of the AURORA-1 trial, voclosporin became licensed for use in patients with lupus nephritis (LN). In 2024 its use was recommended in the KDIGO guidelines. Used in combination with mycophenolate mofetil it allowed for the rapid taper of steroids and significantly increased the number of patients achieving complete renal response (CRR) when compared to mycophenolate mofetil and steroids alone.
Methods
We commenced 10 patients, with biopsy-proven LN, on voclosporin between 2023-2024. We prospectively collected their data specifically looking at, estimated glomerular filtration rate (eGFR ml/min), serum creatinine, complement levels (C3/C4), dsDNA and urine protein:creatinine ratio (uPCR mg/mol). At 12 months we compared our outcomes with those published in the AURORA-1 trial. Complete renal response was defined as uPCR < 0.5 mg/mmol, eGFR > 60 ml/min or no more than a 20 % decrease in eGFR from baseline and no prednisolone more than 10 mg per day for 3 consecutive days.
Results
All 10 patients had LN (class III, IV, V alone or in combination with III or IV). All were female, 5 were black, 4 white and one Asian. Two patients did not complete 12 months of voclosporin and were not included in subsequent analysis. Median eGFR prior to initiation of voclosporin was 79 ml/min and median uPCR 337 mg/mmol. At 12 months median uPCR fell to 164 mg/ml and median eGFR 77 ml/min. Median dsDNA also fell from 42 to 20 (IU/ml). Two patients out of 8 achieved CRR as defined above, one had active class IV another had class III and V. Average prednisolone dose was 4 mg and two patients were able to be weaned of prednisolone completely.
Conclusion
Although less than the 41 % of patients achieving CRR stated in the AURORA-1 trial, our small and real-world cohort has shown that adding voclosporin improved overall renal response rate.When considering the side effect profile, most patients tolerated voclosporin. One person who discontinued voclosporin suffered with abdominal pain, interestingly they had a similar side effect when using another calcineurin inhibitor. The other person discontinued voclosporin for a short period time due to a respiratory tract infection and has since re-instated voclosporin. In our experience, those who have good secretory renal function but are heavily proteinuric benefit from voclosporin add-on therapy in LN.