The 2020 ACR Review Course: Key Issues Rheumatologists Face

Dr. Kavanaugh spent time discussing each topic, the research related to each theme that exists currently, and the possible ways that these issues may evolve in the years to come.

Lupus Nephritis
Finally, Liz Lightstone, MBBS (Hons), PhD, FRCP, professor of renal medicine in the Centre for Inflammatory Disease, Department of Immunology and Inflammation in the Faculty of Medicine, Imperial College London, spoke on diagnosis and treatment updates in lupus nephritis. Three major trials were discussed in her talk.

In the NOBILITY phase 2 study of obinutuzumab, treatment with this type II anti-CD20 monoclonal antibody, when added to mycophenolate mofetil and corticosteroids, was found to result in increased complete and partial renal responses compared with placebo at one year of follow up and was not associated with increased rates of serious adverse events or serious infections.¹⁵

In the BLISS-LN study, more patients with active lupus nephritis who were receiving belimumab plus standard therapy had a primary efficacy renal response than those who received standard therapy alone (43% vs. 32%, respectively).¹⁶

Finally, in the AURORA study, the addition of the calcineurin inhibitor voclosporin to mycophenolate mofetil and low-dose steroids in active lupus nephritis patients resulted in a statistically superior and faster renal response rate vs. standard of care.¹⁷  

Dr. Lightstone noted that standard of care for lupus nephritis still involves induction therapy with either mycophenolate mofetil or cyclophosphamide, along with corticosteroids, but that treatment options are expanding and that patient considerations, such as adherence to treatment, desire for pregnancy, level of renal function impairment and, to a certain degree, cost, should be taken into account.

With 2020 already making history, this excellent ACR Review Course was another reason why clinicians will not soon forget the past 12 months and, hopefully, continue to allow the field of rheumatology to advance.

Jason Liebowitz, MD, completed his fellowship in rheumatology at Johns Hopkins University, Baltimore, where he also earned his medical degree. He is currently in practice with Skylands Medical Group, N.J.

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