Abstract: SA-PO0798
Double Trouble for Lupus Nephritis: Belimumab Meets the Calcineurin Inhibitor
Session Information
- Glomerular Diseases: Lupus Nephritis, Monoclonal Gammopathy-Related Disease, and Transplantation
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Turner, Sarah, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
- Ruiz, Brian, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
- Ike, Joanne, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
- Habbach, Amr, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
- Manocha, Sonia J., Allegheny Health Network, Pittsburgh, Pennsylvania, United States
- Arora, Swati, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
Introduction
Lupus nephritis (LN) remains a major cause of morbidity and mortality in systemic lupus erythematosus (SLE). Current guidelines recommend glucocorticoids with immunosuppressive therapy and support add-on use of either belimumab or calcineurin inhibitors (CNIs), such as voclosporin or tacrolimus. However, evidence for combined belimumab and CNI therapy remains limited. Here, we report the outcomes of five patients with biopsy-proven LN treated with combination belimumab and CNI therapy.
Case Description
We present a series of five female patients between the ages of 34 and 47 with SLE and biopsy-proven LN. All patients were treated with background standard-of-care therapy consisting of mycophenolate mofetil, prednisone taper, and hydroxychloroquine (HCQ). Therapy was upgraded to quadruple regimen in three patients due to worsening proteinuria and two patients due to worsening extrarenal symptoms. The treatment response is shown in the table below. On follow up, renal function stabilized and serologies improved. No serious infections, hospitalizations, or major treatment-related adverse events were documented during the observation period (mean of 15.2 months).
Discussion
The rate of progression of LN to ESRD with the current treatment guidelines necessitates innovative strategies in management. The evidence on combined use of Belimumab and CNIs has shown some promising results but remains limited to case reports/ case series. The utility and safety of using multitarget therapy in LN is not well established. We report our center’s experience in treating 5 LN patients with multitarget therapy showing improvement in proteinuria, extra-renal manifestations and stabilization of renal function without the need for infectious prophylaxis and without infection related hospitalizations. Trials are much needed to evaluate this approach.
Patient Demographics and Treatment Response
| Case | Age | Gender | LN Class | Reason for Adding CNI/Belimumab | Months on CNI plus Belimumab | Treatment Response | Prednisone Dose | Adverse Events |
| 1 | 34 | Female | III | CNI added due to worsening proteinuria | 22 | Proteinuria improved from 2 g/g → 0.15 g/g | Completely weaned off | None |
| 2 | 47 | Female | IV/V | Belimumab added due to worsening extra renal symptoms | 24 | Proteinuria improved from 0.61 g/g → 0.08 g/g, extra renal symptoms improved | 6 mg daily | None |
| 3 | 39 | Female | III | Belimumab added due to worsening extra renal symptoms | 15 | Proteinuria remained negligible, extra-renal symptoms improved | Completely weaned off | None |
| 4 | 41 | Female | V | CNI added due to worsening nephrotic syndrome | 5 | Proteinuria improved from 5 g/g → 0.67 g/g | 15 mg daily; currently weaning off | Serum Cr increased 0.89 mg/dL → 1.11 mg/dL and developed tremors with Voclosporin 23.7 mg BID, both improved with decreased dose to 15.8 mg BID |
| 5 | 34 | Female | III | CNI added due to worsening proteinuria | 10 | Proteinuria improved from 1.4 g/g → 0.18 g/g | 8 mg daily; currently weaning 1 mg/month | None |