Case Series of the Combination of Voclosporin and Belimumab Treatment of Lupus Nephritis
Published on April 30, 2026
Abstract
Introduction: Lupus nephritis (LN) remains challenging with high treatment failure and relapse rates. Current therapies often fail to achieve sustained renal remission. The objective of this research was to assess the safety and clinical effectiveness of dual therapy using voclosporin and belimumab in individuals with LN confirmed via kidney biopsy. Methods: Retrospective case series of 16 female patients (median age 36) with kidney biopsy-proven LN treated with voclosporin (15.8–23.7 mg BID) plus belimumab (200 mg SC weekly/IV) between 2012 and 2025 in routine clinical practice. Baseline was defined as the laboratory value closest to the first kidney biopsy. Longitudinal data for urine protein-to-creatinine ratio (UPCR), serum creatinine, C3/C4 complement, and anti-dsDNA antibodies were analyzed using the Wilcoxon signed-rank test. Results: Initiation of voclosporin and belimumab was associated with a marked reduction in proteinuria, with median UPCR declining from 2.175 g/g to 0.082 g/g and remaining low at final follow-up (0.131 g/g; all p ≤ 0.0005). Serologic markers improved concurrently, with increases in complement levels (C3 65.0–109.5, C4 6.5–20.5) and a decline in median anti-dsDNA (51.5–12.0). 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. Conclusions: 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.