The Inverted Pyramid Approach: Early Combination Therapy With Voclosporin and Obinutuzumab in Active Lupus Nephritis

Achieving remission or low disease activity in systemic lupus erythematosus reduces long-term organ damage, disease flares, and corticosteroid exposure. Kidney involvement from lupus nephritis is often progressive and associated with adverse long-term outcomes. Early, effective immunosuppression during the active inflammatory phase of lupus nephritis is linked to improved renal outcomes. Although voclosporin and obinutuzumab have each demonstrated efficacy in lupus nephritis, real-world data on their combined use remain limited. Here, we report outcomes in three patients with active lupus nephritis who were treated with both Food and Drug Administration (FDA)-approved agents.