Medication Prescribing

Survey Results Show Prescribing Trends for Lupus Nephritis Among Nephrologists and Rheumatologists

For lupus nephritis (LN), rheumatologists prefer prescribing belimumab, while nephrologists prefer prescribing voclosporin, a recent survey finds. Moreover, nephrologists wait longer to begin using these drugs because of cost concerns and uncertainty about risk-benefit compared with tacrolimus. These results were presented at the American Society of Nephrology 2021 Kidney Week.

To determine uptake of belimumab and voclosporin—2 recently approved drugs for the treatment of lupus nephritis—and perceptions among US nephrologists and rheumatologists, researchers from the Spherix Advanced Analytics Group used online surveys to collect data in 4 waves between February 2021 and May 2021. The surveys assessed the prescribing intentions and opinions of 50 nephrologists and 50 rheumatologists in the United States who were actively treating patients with LN. The researchers then followed up these online surveys with qualitative interviews of a subset of survey participants.

The researchers found that rheumatologists consider more of their patients with LN to be candidates for belimumab, which they tend to rate higher than voclosporin on safety and tolerability. In contrast, nephrologists consider their patients with LN better suited to receive voclosporin treatment, which they see as more of a treatment advance than belimumab, and whose calcineurin-inhibitor drug class they are more familiar with. 

Both specialty groups tend to use belimumab in late-line therapy for mild to moderate disease and voclosporin as even later-line therapy for moderate to severe disease. Both medications are typically used with an antimalarial, mycophenolate mofetil, or a steroid and are often chosen for their steroid‑sparing effects. However, rheumatologists consider both belimumab and voclosporin to be greater advances in LN treatment than do nephrologists.

Whereas rheumatologists most often begin voclosporin for Stage 2 chronic kidney disease, nephrologists most often do so for Stage 3, when patients show proteinuria and experience fatigue.

“Physician understanding and comfort level with belimumab and voclosporin [mechanisms of action] are driving early use and perceptions of the two new LN drugs,” the researchers concluded.

—Ellen Kurek


Hurtado TB, Robinson J, Rex R. New drugs and evolving treatment patterns in lupus nephritis: how nephrologists and rheumatologists are responding differently to new treatment options. Paper presented at: ASN 2021 Kidney Week; November 4-7, 2021; Virtual.