Dr. Furie also urged rheumatologists to familiarize themselves with the safety profiles of drugs they prescribe so they can explain them to patients.
Having Options
The 2024 ACR Guideline for the Screening, Treatment, and Management of Patients with Lupus Nephritis recommends triple therapy for active proliferative lupus nephritis, Dr. Furie notes.4 Triple therapy consists of glucocorticoids and two additional immunosuppressive therapies, which can include mycophenolate or cyclophosphamide and a biologic.
Soon obinutuzumab will be one of the available and recommended biologics that could be added to mycophenolate, in addition to belimumab and voclosporin. “Everyone will have a different opinion about which drug(s) to use, and we’ll need to figure this out,” Dr. Furie notes.
He envisions a future with three approaches for eliminating B cells. They include monoclonal antibodies and two new approaches. The first novel approach, called chimeric antigen receptor T (CAR T) cell therapy, involves engineering immune cells to recognize and kill B cells. CAR T requires collecting patients’ T cells, adding chimeric antigen receptors to them, and then returning the T cells to the patient. The second novel approach is the T cell engaging bispecific antibodies that target both a B cell protein and the CD3 molecule on T cells, he says. This latter approach achieves B cell depletion without the requirement of administering living cells.
“Personalizing medication choices is an important area that research needs to pursue,” Dr. Furie emphasizes. “We have come a long way in the development of drugs for our patients with lupus. No doubt there will be more therapies coming, and all these research activities translate into better outcomes for our patients with lupus.”
Deborah Levenson is a writer and editor based in College Park, Md.
References
- Furie RA, Rovin BH, Garg JP, et al. Efficacy and safety of obinutuzumab in active lupus nephritis. N Eng J Med. 2025 Apr 17;392(15):1471–1483.
- Gomez Mendez LM, Cascino MD, Garg J, et al. Peripheral blood B cell depletion after rituximab and complete response in lupus nephritis. Clin J Am Soc Nephrol. 2018 Oct 8;13(10):1502–1509.
- Furie RA, Aroca G, Cascino MD, et al. B-cell depletion with obinutuzumab for the treatment of proliferative lupus nephritis: A randomised, double-blind, placebo-controlled trial. Ann Rheum Dis. 2022 Jan;81(1):100–107.
- Sammaritano LR, Askanase A, Bermas BL, et al. 2024 American College of Rheumatology (ACR) guideline for the screening, treatment, and management of lupus nephritis. Arthritis Rheumatol. 2025 Sep;77(9):1115–1135.
Acknowledgment
Dr. Furie is an investigator and consultant to Genentech.
