Abstract: SA-PO0810
Long-Term Use of Voclosporin as Rescue Therapy in Patients with 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
- Berbari, Iskandar, Emory University School of Medicine, Atlanta, Georgia, United States
- Kim, Paul, Emory University School of Medicine, Atlanta, Georgia, United States
- Stielow, Sean Ryan, Emory University School of Medicine, Atlanta, Georgia, United States
- Waheed, Sana, Emory University School of Medicine, Atlanta, Georgia, United States
- Cobb, Jason, Emory University School of Medicine, Atlanta, Georgia, United States
Background
Our aim is to examine the role of Voclosporin (VCS) as rescue therapy in patients with Lupus Nephritis (LN) refractory to 1st line treatment. The VCS trials excluded patients receiving therapies other than Mycophenolate (MMF). We previously reported 24-week outcome data for VCS in our urban predominantly Black LN population (Kidney Week 2025). We evaluated the use of long-term VCS in patients who switched from other treatment regimens to VCS/MMF therapy.
Methods
We retrospectively reviewed EMRs from 2 Emory sites (2021–2025) for patients prescribed VCS. Inclusion required at least 52 weeks of follow-up and use of treatment regimens before VCS and MMF. The primary endpoint was complete renal response (CRR), defined as UPCR <0.5 g/g, stable eGFR (>60 mL/min or ≤20% decline from baseline), and treatment duration.
Results
Characteristics of the 15 patients who met the inclusion criteria are in Table 1. CRR was achieved in 11 patients (73.3%) with the addition of VCS. Mean time to CRR was 49 weeks (15-111, SD±29) with VCS/MMF compared to 110.8 (16-314, SD±95.38) on other therapies (p < 0.0001). 4 patients did not achieve CRR with any therapy.
Conclusion
Addition of VCS showed similar efficacy (46.6%) in our patients at 52 weeks compared to AURORA-1 (41%), but greater long term CRR (73.3%) compared to AURORA-2 (50.9%). Key differences was that it was a minority population (93% Black or Latino), with a higher percentage of Class V LN. This 1st study of VCS/MMF as rescue therapy showed response time was reduced from 110.8 to 49 weeks. CRR improved from 46.6% at 52 weeks to 73.3% overall (up to 111 weeks), highlighting the importance of longer treatment. Despite a small sample size, these findings demonstrate efficacy in a population not represented in RCTs.
Characteristics of 15 patients treated with VCS/ MMF as rescue therapy
| Baseline | At 52 Weeks | |
| Number | 15 | |
| Race Black, Number (%) | 12 (80) | |
| Ethnicity Latino, Number (%) | 2 (13) | |
| Class of Lupus Nephritis | ||
| Class IV | 2 (13) | |
| Class V | 7 (47) | |
| Class III/V | 4 (27) | |
| Class IV/V | 2 (13) | |
| Serum Creatinine mg/dL, Mean (Range +/- SD) | 0.81 mg/dL (0.4-1.39, ±0.30) | 0.87 mg/dL (0.35-1.64, ±0.36) |
| eGFR ml/min/1.73 m2, Mean (Range +/- SD) | 99.9 ml/min (46-139, ±27.7) | 96.2 ml/min (40-139 ±29.06) |
| Urine Protein to Creatinine Ratio g/g, Mean (Range +/- SD) | 3.85 g/g (0.81-18.4, ±4.38) | 0.89 g/g (0.07-3.32, ±0.94) |