Physician understanding and comfort level with belimumab and voclosporin are driving early use of these recently approval lupus nephritis (LN) drugs.

“Nephrologists are currently more likely to favor voclosporin in the clinical setting for their lupus nephritis patients, while rheumatologists are more likely to favor belimumab,” Jennifer Robinson, president of Spherix Global Insights, noted in an presentation at the American Society of Nephrology’s Kidney Week 2021.

Her team conducted a series of online surveys and interviews from February to August 2021 involving 50 nephrologists and 50 rheumatologists. Familiarity with both drugs increased over time. By August, 46% of nephrologists vs 24% of rheumatologists reported familiarity with voclosporin, a calcineurin inhibitor, whereas 42% of nephrologists vs 74% of rheumatologists reported familiarity with belimumab, a monoclonal antibody that inhibits B-cell activating factor.

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More rheumatologists than nephrologists viewed belimumab (34% vs 28%) and voclosporin (34% vs 24%) as a “substantial advance” in LN treatment.

Nephrologists consistently estimated that a quarter of their patients with LN were candidates for voclosporin, likely reflecting their ease with using calcineurin inhibitors in kidney transplant recipients, according to the investigators. Rheumatologists estimated that 25%-33% of their patients could benefit from belimumab, probably stemming from their experience using the drug to treat systemic lupus erythematosus (SLE). By August, 42% and 40% of nephrologists reported prescribing belimumab and voclosporin, respectively, whereas 88% of rheumatologists prescribed belimumab and 40% prescribed voclosporin. Nephrologists only had 1-2 mean patient initiations for either drug, whereas rheumatologists had 6-7 mean initiations for belimumab (including 1 discontinuation).

In a head-to-head comparison of both drugs in August, nephrologists favored voclosporin for efficacy (34%) and safety (32%), whereas rheumatologists were evenly split on the drugs’ efficacy and favored belimumab for safety (50%).

According to Robinson, “rheumatologists are the leading prescribers of belimumab, and currently have a slight edge with voclosporin patient initiations as well. Nephrologists are tending to wait longer to initiate, due to cost- and risk-benefit uncertainty compared to other options like tacrolimus.”

A majority of both specialists viewed belimumab and voclosporin as second- or third-line therapy for moderate to severe LN, commonly to reduce steroid burden, Robinson reported.


Robinson J, Hurtado T, Rex R. New drugs and evolving treatment patterns in lupus nephritis: How nephrologists and rheumatologists are responding. Presented at: Kidney Week 2021, November 2-7, 2021. Presentation PO1435.