Future Treatment Landscape for Patients With LN

In their closing thoughts, experts emphasize their optimism regarding the direction of LN treatment strategies and resources.

Jorge Larranaga, MD: Looking at the future treatment of lupus nephritis, over these last 2 years, the new data have stimulated our palate and increased our hunger for more research and advancements in this disease and others alike. Nephrology has been stagnant in the research of lupus and other entities. As we see more data come out, we hope that we see more new drugs and more pharmaceutical companies interested in coming out with different drugs with different mechanisms of action that can help in the adjuvant therapy of these patients.

As I alluded to earlier, it’s very important to proceed in a quality MOA [mechanism of action] approach and aggressive fashion for these patients from the beginning and avoid chasing your tail retrospectively to try to suppress the disease state. As we often say, be aggressive; go big or go home. A lot of times, that’s what differentiates practices and physicians. We recognize that this entity has lacked attention for so many years, and we’ve left it at the status quo of failure, leading these patients to mortality and end-stage renal disease. I encourage pharmaceutical companies and other entities to further research potential different mechanisms of action to reach the ultimate outcomes of these patients. Thank you.

Alvin Wells, MD, PhD: Many of my colleagues don’t like to treat lupus and lupus nephritis because they don’t think they have great treatment options. But I’m very excited because as we get close to the end of the year and beginning of a new year, we do have other treatments. First, we have a target. You want to get the proteinuria under control. I want to look at that urinary protein-to-creatinine ratio. I want to have that target. Once you have that, that’s my goal. I set that goal with the patient. Now we’re doing everything we can as a rheumatologist or nephrologist to get that disease [under control] and make sure we reach that target.

One of the exciting things we’re saying is, maybe for the patients diagnosed with lupus nephritis, today they start one drug. If they don’t get better, start another drug. If they don’t get better, start another drug. Maybe we should start a more aggressive therapy up front, doing more of an induction regimen, and then begin to back down on these medications as they respond. One drug we want to get rid of or get to the lowest dose possible as quickly as possible is the corticosteroids. That’s exciting. We have evidence going out to 2 years with a drug such as voclosporin that shows that in patients with lupus nephritis, we can get their disease under control, 80% of patients only require 2.5 mg of prednisone, and many of these patients will maintain their renal function over 2 years. As a rheumatologist, that’s exciting in treating patients with lupus nephritis.

Transcript edited for clarity.

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