Glucocorticoid exposure remains a major contributor to morbidity and mortality in patients with immune-mediated kidney disease. Recent clinical trials have tested novel potential therapies for these patients and showed that glucocorticoid doses can be reduced without compromising efficacy.
Key advances
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C5a receptor antagonism with avacopan is effective in combination with cyclophosphamide or rituximab for inducing and maintaining remission in severe anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) and reduces glucocorticoid requirements.
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Reducing glucocorticoid dose with rituximab for the induction of remission in AAV does not compromise short-term efficacy and reduces serious infections.
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Use of the calcineurin inhibitor voclosporin with mycophenolate mofetil (MMF) and glucocorticoids improves renal response in patients with class III–V lupus nephritis and eGFR >45 ml/min/1.73 m2.
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Obinutuzumab combined with MMF and glucocorticoids increases renal response in patients with class III–IV lupus nephitis.
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Inhibition of sodium–glucose co-transporter 2 with dapagliflozin in proteinuric IgA nephropathy improves renal outcomes.
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References
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A.K. has received consultancy fees from Vifor Pharma, Alexion, Otsuka and Catalyst Biosciences. R.B.J. has received grants from GSK and Roche, and has consulted for Chemocentryx, Vifor Pharma and GSK.
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Kronbichler, A., Jones, R.B. Improving outcomes in glomerular disease. Nat Rev Nephrol 18, 82–83 (2022). https://doi.org/10.1038/s41581-021-00526-z
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DOI: https://doi.org/10.1038/s41581-021-00526-z
