Abstract: SA-PO0854
Specialty and Phenotype Patterns in Biologic- and Calcineurin Inhibitor (CNI)-Based Combination Therapy for Lupus Nephritis
Session Information
- Glomerular Diseases: Management, Evolving Strategies, and Practice-Changing Advances
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
- May, Sawyer Alexander, Spherix Global Insights, Exton, Pennsylvania, United States
- Rex, Ryan, Spherix Global Insights, Exton, Pennsylvania, United States
- Price, Lynn, Spherix Global Insights, Exton, Pennsylvania, United States
Background
Contemporary LN guidance supports add-on biologic or CNI therapy with background MMF or CYC, yet real-world adoption and patient selection across specialties remain inconsistent.
Methods
An analysis was conducted of 1,074 non-dialysis adult LN charts from US nephrologists (522 charts; 89 physicians) and rheumatologists (552 charts; 111 physicians), collected between September and October, 2025. Patients had Class III/IV (+/-V) or Class V LN and an eGFR ≥15.
Results
Biologic/CNI-containing MMF/CYC combinations were used in 50% of rheumatology and 36% of nephrology patients. The specialty gap was driven mainly by biologic-containing regimens: MMF/CYC plus biologic +/- steroids was used in 33% of rheumatology and 21% of nephrology charts. CNI-only combinations were slightly more common in nephrology (13% vs 10%), while concomitant biologic and CNI regimens were uncommon but more frequent in rheumatology (7% vs 2%).
Guideline-endorsed combination use was lowest in Class III LN (24% nephrology; 41% rheumatology) and highest in membranous phenotypes (39%-45% and 49%-55%, respectively). CNI-containing regimen use peaked in Pure Class V disease (24% and 23%).
Median UPCR at LN diagnosis was higher for CNI combinations (2.8g/g) than biologic combinations (2.0g/g). Despite higher UPCR at treatment initiation among voclosporin-treated patients, most-recent UPCR levels were comparable between voclosporin and belimumab patients.
Conclusion
Rheumatologists demonstrated greater adoption of biologic/CNI-containing LN combination regimens than nephrologists, largely reflecting more frequent biologic use. CNIs were not the dominant combination strategy overall, but preferentially used in higher-UPCR and membranous-pattern disease, suggesting real-world selection of biologics as the default add-on and CNIs for proteinuric/membranous phenotypes.
| Drug | Median UPCR at LN diagnosis (g/g) | Median UPCR at drug initiation (g/g) | Median UPCR at most recent visit (g/g) |
| voclosporin | 2.7 (n=148) | 2.5 (n=156) | 0.8 (n=133) |
| belimumab | 2.0 (n=346) | 1.9 (n=376) | 0.8 (n=319) |