‘A very exciting time’: Voclosporin, cell therapies represent future of lupus treatment
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SAN DIEGO —The recent voclosporin approval and continued research into cell therapies make this a “very exciting time” for lupus nephritis therapy, according to a speaker 2023 Congress of Clinical Rheumatology West.
“The binding affinities for voclosporin and cyclosporin A for cyclophilin are comparable,” Kenneth C. Kalunian, MD, of the University of California San Diego School of Medicine, told attendees. “However, upon binding the sidechain of voclosporin, there is an induction of structural change in calcineurin that may result in increased immunosuppression activity relative to cyclosporin A.”
Due to its ability to reduce urinary protein/creatinine ratio (UPCR), voclosporin (Lupkynis, Aurinia) is a prime candidate for early intervention in patients with lupus nephritis, Kalunian said.
“For me, voclosporin is very effective in reducing UPCR, and I think that leads to greater survival and decreased risk for new flares,” he said. “I think that if we use voclosporin early, we can get an earlier response.”
Meanwhile, the problem regarding early use of voclosporin is present in many immunosuppressive drugs.
“There may be a fibrotic component present with voclosporin,” Kalunian said. “That is common in this class of drugs, and maybe at some point we need to switch to belimumab (Benlysta, GlaxoSmithKline) as the drug of choice for use in combination with mycophenolate mofetil.”
Aside from voclosporin, other development involving cell therapies are cause for excitement, according to Kalunian.
“Lastly, cell-based therapy,” he said. “We are all very excited about the several patients who have been reported receiving CAR-T therapy. There was drug-free remission during the long follow-up of about 8 months.”
Beyond T cells, several other therapies appear to be on the horizon, Kalunian said.
“There are other cell-based therapies on the rise,” he said. “One of particular interest to me is the use of NK cells.”
The potential versatility of NK cells makes them an enticing target for lupus therapeutics, Kalunian said.
“It is a very exciting time to do what I do,” he said. “I wake up every morning excited to find new findings.”
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Kalunian KC. Lupus in 2023: A new era. Presented at The Congress of Clinical Rheumatology West; Sept. 7-10, 2023 (hybrid meeting).
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