KDIGO releases updated guidelines on lupus nephritis
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Key takeaways:
- The guideline was revised after two drugs received FDA approval for the treatment of lupus nephritis.
- The most significant update involved initial treatment of proliferative lupus nephritis.
Kidney Disease: Improving Global Outcomes has released a revised clinical practice guideline for the treatment of lupus nephritis.
The guideline, published as a supplement in the January issue of Kidney International, is an update of the chapter on lupus nephritis from the KDIGO Clinical Practice Guideline for the Management of Glomerular Diseases released in 2021.
“This guideline offers critical insights into navigating the complexities of [lupus nephritis] LN treatment, especially with the introduction of novel therapies, and highlights the need for individualized therapy selection based on patient-specific factors and clinical scenarios,” Brad H. Rovin, MD, co-chair of the guideline review, said in a press release. “With ongoing trials evaluating additional novel therapeutics and promising new data on the horizon, the guideline sets the stage for future advancements in the management and treatment of LN.”
Changes to the guideline were initiated by KDIGO after the FDA and the European Medicines Agency approved use of belimumab (Benlysta, GlaxoSmithKline) and voclosporin (Lupkynis, Aurinia Pharmaceuticals) for the treatment of lupus nephritis.
“These additions to the therapeutic armamentarium for the treatment of LN energized patients and providers in the lupus community with the promise of superior response rates compared to [standards of care] SOC alone,” Rovin and colleagues wrote in the guideline. “At the same time, however, the availability of new therapies raised important questions of how best to apply them.”
In the revised guideline, Rovin and colleagues said the “most significant update” involved initial treatment of proliferative LN. The authors recommend that patients with active class III or IV LN be treated initially with glucocorticoids along with one of the following:
- mycophenolic acid analogs (MPAA);
- low-dose IV cyclophosphamide;
- belimumab and either MPAA or low-dose IV cyclophosphamide; or
- MPAA and a calcineurin inhibitor.
The recommendations are when kidney function “is not severely impaired (ie, 45 mL/min/1.73 m2),” the authors wrote, and with or without a membranous component.
Jürgen Floege, MD, of the division of nephrology, University Hospital, Rheinisch-Westfälische Technische Hochschule in Aachen, Germany, served as co-chair of the guideline review.
Reference:
KDIGO announces publication of 2024 lupus nephritis guidelines https://kdigo.org/kdigo-announces-publication-of-2024-lupus-nephritis-guideline/. Published Jan. 3, 2024. Accessed Feb. 6, 2024.
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