Management

Test Your Knowledge: Managing Lupus Nephritis

  • Correct Answer: D. Keep the same regimen and reassess the patient after 3 months of therapy.

    The patient has shown more than 25% improvement of the proteinuria within the last 2 months, which is a good prognostic factor and predicts a good response.1 Answer A is not correct because a subgroup analysis of patients with lupus nephritis showed that adding belimumab to intravenous cyclophosphamide did not statistically significantly improve renal responses.2 Answers B and C are not correct because the dose of voclosporin should be lowered in patients taking diltiazem—a moderate cytochrome P450 3A4. Diltiazem would reduce voclosporin metabolism and can increase the serum level. Moreover, the voclosporin dose of 23.7 mg is potentially toxic when given with diltiazem and should be lowered.

    References:

    1. Dall'Era M, Levesque V, Solomons N, Truman M, Wofsy D. Identification of clinical and serological factors during induction treatment of lupus nephritis that are associated with renal outcome. Lupus Sci Med. 2015;2(1):e000089. https://doi.org/10.1136/lupus-2015-000089

    2. Furie R, Rovin BH, Houssiau F, et al. Two-year, randomized, controlled trial of belimumab in lupus nephritis. N Engl J Med. 2020;383(12):1117-1128. https://doi.org/10.1056/nejmoa200118