Lupkynis (voclosporin) / Aurinia Pharmaceuticals, Otsuka - LARVOL DELTA

Comparative Efficacy and Safety of Voclosporin, Belimumab, and Obinutuzumab in Lupus Nephritis: A Systematic Review and Network Meta-Analysis of 9 Randomized Controlled Trials (ACR Convergence 2026) - No abstract available

Retrospective data • Review • Glomerulonephritis • Immunology • Inflammatory Arthritis • Lupus • Lupus Nephritis • Nephrology

Voclosporin vs. Belimumab in Lupus Nephritis: Two-Year Renal Outcomes in a Retrospective Propensity Score-Matched Real-World Cohort (ACR Convergence 2026) - No abstract available

Real-world • Real-world evidence • Retrospective data • Glomerulonephritis • Immunology • Inflammatory Arthritis • Lupus • Lupus Nephritis • Nephrology

Drug-Drug Interactions Between Oral Anticoagulants and Calcineurin Inhibitors in Nephrotic Syndrome for Management of Thromboembolism. (PubMed, Biomedicines) - "Thromboembolism is a life-threatening complication of nephrotic syndrome, which is treated with oral anticoagulants (warfarin and direct oral anticoagulants [DOACs]) that possess a variety of pharmacokinetic characteristics. This narrative review focused on drug-drug interactions between oral anticoagulants and calcineurin inhibitors (CNIs) (e.g., tacrolimus, cyclosporine, and voclosporin) for the management of thromboembolism in nephrotic syndrome...Limited evidence suggests that more pronounced drug interactions occur in specific cases: (1) apixaban and CNIs in patients with renal impairment, (2) edoxaban combined with cyclosporine in patients with renal impairment, and (3) a combination of rivaroxaban with dual inhibitors of P-glycoprotein and CYP3A4 (e.g., cyclosporine and fluconazole)...In addition, the variation factors of pharmacokinetic parameters, such as renal function, pharmacogenomic profiles, and pathophysiological changes directly caused by nephrotic..."

Journal • Review • Cardiovascular • Glomerulonephritis • Hypertension • Nephrology • Renal Disease • CYP3A4

Voclosporin for the treatment of lupus nephritis flares in patients with inadequate response to mycophenolate mofetil and belimumab: a case series. (PubMed, J Nephrol) - "Finally, the third report describes a woman who developed an LN flare shortly after starting belimumab. In all three cases, voclosporin effectively controlled LN relapses, with treatment generally being well tolerated and no clinically relevant adverse events observed, highlighting its potential role in treating nephrotic LN flares, as suggested by the most recently published treatment guidelines."

Journal • Acute Kidney Injury • Glomerulonephritis • Immunology • Inflammatory Arthritis • Lupus • Lupus Nephritis • Nephrology • Renal Disease • Systemic Lupus Erythematosus

MAPLE: Assessing Residual Inflammation and Macrophage Presence in Lupus Nephritis After 3 Months of Intensified Treatment With Prednisolone, Mycofenolate Mofetil and Voclosporin as Compared to Mycofenolate Mofetil and Prednisolone (clinicaltrials.gov) - P4 | N=55 | Recruiting | Sponsor: Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)

New P4 trial • Glomerulonephritis • Immunology • Inflammation • Inflammatory Arthritis • Lupus • Lupus Nephritis • Nephrology • Systemic Lupus Erythematosus

Advances in the treatment of systemic lupus erythematosus: Biologicals, small-molecular agents, and cell-depleting therapies coming to the clinic. (PubMed, J Intern Med) - "Over the past few years, several new biological therapeutics have been approved for the treatment of SLE (belimumab and anifrolumab) or specifically for its renal organ manifestation (obinutuzumab), along with one new small molecular treatment for the latter (voclosporin). Several additional biologicals (litifilimab and dapirolizumab) and small molecules (deucravacitinib, upadacitinib, and cerenimod) are in late-stage clinical development...A reasonable expectation is that in the coming 1-2 years, several additional biologicals and small-molecular agents will be approved for the treatment of lupus. The most important conclusion is that the future for our patients with lupus looks brighter than ever before."

Journal • Review • Immunology • Inflammatory Arthritis • Lupus • Systemic Lupus Erythematosus

Childhood-Onset Lupus Nephritis in the Era of Triple Therapy and Steroid Minimization. (PubMed, Children (Basel)) - "Contemporary guidance has moved from prolonged high-dose glucocorticoids and cyclophosphamide-dominant treatment toward biopsy-driven, treat-to-target care built around mycophenolic acid analogues, hydroxychloroquine, nephroprotection, rapid steroid tapering, and selected belimumab- or calcineurin-inhibitor-based triple therapy...Pediatric practice must therefore combine adult trial evidence with child-specific caution, explicit adherence strategies, fertility and growth protection, and structured transition planning. The aim should be efficacy without toxicity: not undertreatment, but intelligent, sustainable, developmentally informed treatment."

Journal • Glomerulonephritis • Immunology • Inflammatory Arthritis • Lupus • Lupus Nephritis • Nephrology • Pediatrics • Renal Disease • Systemic Lupus Erythematosus

Network meta-analysis of triple immunosuppressive therapies and standard of care for induction of remission of active lupus nephritis. (PubMed, Lupus) - "In indirect pairwise comparisons, patients who received SOC+Tacrolimus compared to SOC+Rituximab (2.30 [1.27 to 4.20]), SOC+Anifrolumab (1.98 [1.07 to 3.52]), SOC+Ocrelizumab (1.81 [1.12 to 2.82]), and SOC+Abatacept (1.78 [1.07 to 2.91]) had significantly higher PRR...SOC+Belimumab, SOC+Obinutuzumab, SOC+Voclosporin and SOC+Tacrolimus ranked as effective therapies inducing PRR with SUCRA probability scores between 61.14% and 95.12%. Risk ratios of SAE and SIE were not significantly different among the immunosuppressive therapies.ConclusionIn patients with LN, induction therapies of SOC with calcineurin inhibitors had the highest relative benefit achieving remission of LN."

Clinical • Journal • Retrospective data • Glomerulonephritis • Immunology • Inflammatory Arthritis • Lupus • Lupus Nephritis • Nephrology

Lupus nephritis treatment: a comprehensive overview of recent meta-analyses and future directions. (PubMed, Immunotherapy) - "Key findings include: Biological agents, particularly Belimumab and Obinutuzumab, significantly improve complete renal remission (CR) and reduce the risk of end-stage renal disease, breaking through traditional therapeutic bottlenecks. However, rituximab, while effective, carries a higher infection risk (SUCRA = 74.98%). The combination of tacrolimus and mycophenolate mofetil doubled the CR rate compared to monotherapy (OR = 2.85), but requires monitoring for creatinine elevation. Voclosporin use is limited by a high infection risk...Mesenchymal stem cell therapy achieved a 33.7% remission rate. In conclusion, this review provides a comprehensive overview of recent research on LN treatment, offering evidence-based support for clinical decision-making and points out directions for future research."

Journal • Review • Chronic Kidney Disease • Glomerulonephritis • Immunology • Infectious Disease • Inflammatory Arthritis • Lupus • Lupus Nephritis • Nephrology • Ophthalmology • Renal Disease • TNFSF12

KDOQI US Commentary on the KDIGO 2024 Clinical Practice Guideline for the Management of Lupus Nephritis. (PubMed, Am J Kidney Dis) - "The management of LN has become increasingly individualized, and treatment options are expanding; for example, since the release of the KDIGO guideline, the US Food and Drug Administration has approved obinutuzumab in addition to belimumab and voclosporin for the treatment of LN, and the enrollment of patients in chimeric antigen receptor (CAR) T-cell therapy clinical trials is changing the treatment landscape for autoimmune diseases including systemic lupus erythematosus. The KDOQI work group reviewed the KDIGO guideline statements and practice points and provides perspectives for implementation within the context of clinical practice in the United States. This commentary is the product of the KDOQI work group and presents the recommendations and practice points from the KDIGO guideline, followed by commentary and brief notes on clinical utility, implementation, and challenges."

Clinical guideline • Journal • Chronic Kidney Disease • Glomerulonephritis • Immunology • Inflammatory Arthritis • Lupus • Lupus Nephritis • Nephrology • Renal Disease • Systemic Lupus Erythematosus

Immunosuppressive effects of voclosporin in inflammatory bowel disease through targeted inhibition of SLP-76 and metabolic reprogramming. (PubMed, J Immunol) - "Although calcineurin inhibitors such as cyclosporine A (CsA) are used in severe ulcerative colitis, voclosporin (VCS), a novel calcineurin inhibitor approved for lupus nephritis, has not been systematically evaluated in IBD. Metabolomic profiling showed that VCS induced distinct metabolic changes compared with CsA. Our findings highlight SLP-76 as a potential immunoregulatory target in IBD and suggest that VCS exerts broader immunosuppressive effects than CsA, supporting its repurposing as a therapeutic strategy."

IO biomarker • Journal • Crohn's disease • Gastroenterology • Gastrointestinal Disorder • Glomerulonephritis • Immunology • Inflammation • Inflammatory Arthritis • Inflammatory Bowel Disease • Lupus • Lupus Nephritis • Metabolic Disorders • Nephrology • Ulcerative Colitis • CD4 • CD69 • CD8 • LCP2

Voclosporin Preserves Mitochondrial Function Compared With Cyclosporine A in Perfused Human Proximal Tubule Microphysiological Systems. (PubMed, bioRxiv) - "At matched exposure, VCS preserved mitochondrial function and proteostasis while eliciting a narrower, adaptive ER quality control response. These data support VCS as a nephron-sparing immunosuppressant and 3D MPS as a mechanism-based platform for evaluating renal safety of drugs and nominating early sub-lethal tubular injury biomarkers."

Journal • Transplantation • CDKN1A • KIM1

Navigating the therapeutic landscape: Biologics and immunosuppressive therapy in lupus nephritis during pregnancy. (PubMed, Lupus) - "The therapeutic armamentarium for LN has expanded considerably with the approval of voclosporin, belimumab, and obinutuzumab, yet pregnancy safety data for these agents remain conspicuously absent...Key guidelines, pregnancy registries, and landmark clinical trial data were incorporated.ResultsHydroxychloroquine and azathioprine remain the cornerstones of pregnancy-compatible LN management...Low-dose aspirin is recommended universally to reduce preeclampsia risk. Mycophenolate mofetil is teratogenic and absolutely contraindicated in the first trimester...Rituximab may be used cautiously for life-threatening disease, avoiding the third trimester due to neonatal B-cell depletion. Anifrolumab has no pregnancy data and should be reserved for situations where no compatible alternative exists.ConclusionThe growing number of effective LN therapies creates both opportunities and new dilemmas in pregnancy management. A structured, phase-based approach to drug selection - anchored..."

Journal • Review • Acute Kidney Injury • Glomerulonephritis • Gynecology • Immunology • Inflammatory Arthritis • Lupus • Lupus Nephritis • Nephrology • Renal Disease

Aurinia Announces Initiation of PRESERVE, a Study Investigating the Combination of LUPKYNIS and Belimumab, Obinutuzumab or Anifrolumab in Patients with Lupus Nephritis (Businesswire) - "Planned enrollment is approximately 150 patients across approximately 50 sites in the US. The Study’s primary endpoint is the proportion of patients achieving complete renal response (CRR) at 6 months."

Trial status • Lupus Nephritis

Lupus nephritis and kidney transplantation: A narrative review of patient and graft outcomes. (PubMed, World J Nephrol) - "Advances in immunosuppressive therapies, including newly approved agents such as voclosporin and belimumab, have further enhanced LN management. In addition, novel biomarkers such as urinary monocyte chemoattractant protein-1, B-cell activating factor and matrix metalloproteinase-7 show promise for monitoring disease activity and predicting post-transplant recurrence risk. A comprehensive appraisal of guidelines and contemporary studies is essential to refine management strategies and optimize long-term outcomes for patients with LN undergoing KT."

Journal • Review • Chronic Kidney Disease • Glomerulonephritis • Immunology • Inflammatory Arthritis • Lupus • Lupus Nephritis • Nephrology • Systemic Lupus Erythematosus • Transplantation • CCL2 • MMP7

Case Series of the Combination of Voclosporin and Belimumab Treatment of Lupus Nephritis. (PubMed, Glomerular Dis) - "62.5% of patients tapered corticosteroids to ≤5 mg/day or discontinued them, while serum creatinine increased modestly from 0.77 to 0.89 mg/dL. The combination of voclosporin and belimumab is highly effective in inducing rapid and sustained renal remission and facilitating a significant reduction in corticosteroid dose in patients with LN."

Journal • Glomerulonephritis • Immunology • Inflammatory Arthritis • Lupus • Lupus Nephritis • Nephrology • Renal Disease

Management of systemic lupus erythematosus with kidney involvement: systematic literature review to inform the 2025 update of EULAR recommendations. (PubMed, EULAR Rheumatol Open) - "A combination of 2 immunosuppressive agents, such as belimumab with mycophenolate mofetil (MMF)/cyclophosphamide, voclosporin with MMF, or obinutuzumab with MMF, is associated with higher response rates, based on high-quality randomised controlled trials (RCTs). Patients who respond within the first year of treatment tend to have better long-term outcomes. Kidney biopsy is essential for diagnosis, but the role of repeat biopsy awaits confirmation from higher-quality studies."

Journal • Review • Glomerulonephritis • Immunology • Inflammatory Arthritis • Lupus • Lupus Nephritis • Nephrology • Renal Disease • Rheumatology • Systemic Lupus Erythematosus

Evaluating the Efficacy and Safety of Various LupusNephritis Therapies: Systematic Review and Network Meta-analysis (ERA 2026) - "Recent therapeutic trends have shifted from traditional immunosuppressants to emerging agents, such as calcineurin inhibitors (e.g., Tacrolimus, Voclosporin) and biologics (e.g., Belimumab, Rituximab, Obinutuzumab, Anifrolumab). Treatment decisions should carefully balance superior efficacy against these drug-specific safety profiles. Image"

Retrospective data • Review • Glomerulonephritis • Infectious Disease • Inflammatory Arthritis • Lupus • Lupus Nephritis • Nephrology

Evaluation of Puromycin-Induced Podocyte Injury and Protective Effects of Voclosporin Using Induced Pluripotent Stem Cells from a Patient with Nephrotic Syndrome Harboring an INF2 Variant. (PubMed, Stem Cells Dev) - "Cyclosporine A (CsA) or voclosporin (VCS) was administered as a 1-h pretreatment before PAN exposure to evaluate their podocyte-protective effects. In conclusion, we established a patient-specific kidney organoid model of INF2-associated FSGS that reliably recapitulated podocyte vulnerability to toxic injury. This platform demonstrated that calcineurin inhibitors, including the novel agent VCS, exert direct podocyte-protective effects in a genetic FSGS background and provide a practical system for mechanistic studies and therapeutic screening."

Journal • Chronic Kidney Disease • Focal Segmental Glomerulosclerosis • Glomerulonephritis • Nephrology • Renal Disease • PODXL

SPANISH REAL-WORLD EXPERIENCE OF VOCLOSPORIN IN LUPUS NEPHRITIS (ERA 2026) - No abstract available

Clinical • Real-world • Real-world evidence • Glomerulonephritis • Immunology • Inflammatory Arthritis • Lupus • Lupus Nephritis • Nephrology

Renal Outcomes with Obinutuzumab and Voclosporin in Lupus Nephritis (ERA 2026) - "The 12-month obinutuzumab response rate appears broadly consistent with REGENCY, though CRR i n our cohort was lower than reported in the trial; comparison with voclosporin trial outcomes is limited by small numbers and reduced follow-up in our cohort. Image"

Cardiovascular • Chronic Kidney Disease • Glomerulonephritis • Hypertension • Immunology • Infectious Disease • Inflammatory Arthritis • Lupus • Lupus Nephritis • Nephrology • Pneumonia • Respiratory Diseases

Voclosporin or Tacrolimus? (ERA 2026) - No abstract available

Immunology • Lupus • Lupus Nephritis

Real-world outcomes of combination immunosuppressive therapy in lupus nephritis: high response rates and significant corticosteroid reduction (EULAR 2026) - "The most frequently used ISU agents were mycophenolate mofetil (n=53), rituximab (n=25), voclosporin (n=21), belimumab (n=16), and intravenous cyclophosphamide (n=8), with tacrolimus, cyclosporin-A azathioprine and obinutuzumab in some other patients (Figure). Conclusions Combination ISU therapy is an increasingly utilized and effective strategy for managing active LN in clinical practice. This approach yields high renal response rates, demonstrates a significant steroid-sparing effect, and shows high patient retention, supporting its suitability for long-term management."

Clinical • Real-world • Real-world evidence • Glomerulonephritis • Immunology • Infectious Disease • Inflammatory Arthritis • Lupus • Lupus Nephritis • Nephrology

Advances and unmet needs in the management of proliferative lupus nephritis: evidence, guidelines, and emerging therapies. (PubMed, Kidney Res Clin Pract) - "Although mycophenolate-based regimens and cyclophosphamide remain standard induction therapies, up to one-third of patients have refractory disease, and many fail to achieve a complete renal response, as demonstrated in the ASPREVA, AURORA, and BLISSLN trials...Belimumab improves composite and complete renal response rates when added to standard therapy and reduces renal events, particularly in patients with proliferative histology. Voclosporin, a novel calcineurin inhibitor with predictable pharmacokinetics, increases complete renal response rates and rapidly reduces proteinuria in patients with preserved kidney function...Obinutuzumab, a type II anti-CD20 monoclonal antibody, demonstrated higher complete renal response rates than placebo in a phase 3 trial, albeit with increased serious infections. Anifrolumab, which targets type I interferon signaling, has shown favorable trends in reducing proteinuria and systemic disease activity in early lupus nephritis studies and..."

IO biomarker • Journal • Glomerulonephritis • Immunology • Infectious Disease • Inflammatory Arthritis • Lupus • Lupus Nephritis • Nephrology • Renal Disease • Systemic Lupus Erythematosus • CD40

Real-World Renal Outcomes with Obinutuzumab and Voclosporin in Lupus Nephritis (EULAR 2026) - "Obinutuzumab was associated with stable renal function and sustained immunological improvement, while voclosporin demonstrated rapid proteinuria reduction but was accompanied by declines in eGFR in a subset of patients, leading to treatment discontinuation. These findings highlight the importance of individualised treatment selection and close renal monitoring in routine clinical practice."

Clinical • Real-world • Real-world evidence • Cardiovascular • Glomerulonephritis • Hypertension • Immunology • Infectious Disease • Inflammatory Arthritis • Lupus • Lupus Nephritis • Nephrology • Otorhinolaryngology • Pneumonia • Renal Disease • Respiratory Diseases • Systemic Lupus Erythematosus