2 New Meds Found to Completely Change Lupus Nephritis Treatment
Analysis shows greater use of Lupkynis, sharp drop in rituximab
The approvals of new medications in the last few years have dramatically shifted the treatment landscape for lupus nephritis, a severe manifestation of lupus characterized by kidney inflammation, with a sharp drop found in the use of rituximab.
That’s according to the market research group Spherix Global Insights, which conducted its second annual analysis of lupus nephritis treatment patterns, published at the end of 2022.
Since 2020, two new therapies have been approved by the U.S. Food and Drug Administration (FDA) to treat lupus nephritis: Benlysta (belimumab), marketed by GSK (formerly GlaxoSmithKline), and Lupkynis (voclosporin), marketed by Aurinia Pharmaceuticals.
The analysis showed that, compared with 2021, the use of Lupkynis “expanded significantly, regardless of which specialty was managing the treatment regimen,” according to a new press release from Spherix. The use of Benlysta, meanwhile, remained “relatively flat” from 2021 to 2022, with the therapy being much more commonly prescribed by rheumatologists than by nephrologists.
“Practitioners now have valuable new treatment options to battle this complex and serious condition,” Spherix stated in the release.
Still many patients on high-dose corticosteroids, report finds
The analysis included data from 962 people with the disease in the U.S., as well as insights from 138 rheumatologists — autoimmune disease specialists — and 104 nephrologists, or kidney specialists. The company had conducted a similar analysis for 2021, which also included data on more than 950 patients.
Most patients included in the report were experiencing lupus symptoms in other parts of the body outside the kidneys, most commonly the skin. According to Spherix, Benlysta was more commonly given to patients having more severe skin involvement.
With these new approved treatment options available, the report notes there has been a sharp decrease in the use of rituximab, a cancer therapy used off-label for treating lupus and other autoimmune diseases. For years, rituximab was used in the management of lupus and many other disorders, but it is not formally approved for most of these uses.
Rituximab works by killing B-cells, a type of antibody-producing immune cells that are thought to drive lupus. Benlysta also targets B-cells, albeit through a different mechanism.
Spherix is speculating that reduced use of rituximab “may erode the bridge that most physicians see between rituximab” and Gazyva (obinutuzumab), an experimental treatment for lupus being developed by Roche. Gazyva has a similar mechanism of action to rituximab.
The report also notes that most people with lupus nephritis are being treated with corticosteroids — potent anti-inflammatory medicines that have a high risk of side-effects if used over a long period of time.
Many patients were on doses higher than 5 mg, “which is generally where practitioners become concerned about safety,” according to Spherix.
“With steroid minimization increasingly a key goal in [lupus nephritis] patient management to avoid the serious side effects of the drug class, it is notable that both Benlysta and Lupkynis succeed in achieving this result in a sizable proportion of patients,” the company stated, noting that Benlysta has generally had a better steroid-sparing profile than Lupkynis.
Despite advances in treatment, Spherix’s report states that 40% to 50% of lupus nephritis patients are not optimally managed, so “there is ample opportunity” for developers who are advancing new treatments that may benefit patients. The report noted that Saphnelo and Gazyva are two of the investigational therapies for lupus nephritis being viewed with particular excitement by clinicians.