Voclosporin, marketed under the brand name Lupkynis, is a medication for lupus nephritis. It targets inflammatory processes that damage the kidneys in individuals with lupus, offering a therapeutic option for adults with this serious kidney complication.
Understanding Lupus Nephritis
Lupus nephritis is a severe inflammation of the kidneys that can occur in individuals with systemic lupus erythematosus (SLE), an autoimmune disease where the immune system mistakenly attacks its own tissues, leading to kidney damage. This condition can affect the small filtering units within the kidneys, known as glomeruli, which are responsible for removing waste products and excess water from the blood.
Inflammation from lupus nephritis can impair the kidneys’ ability to filter blood effectively, leading to protein in the urine, swelling, and high blood pressure. If left unaddressed, damage can progress, potentially leading to chronic kidney disease or even end-stage kidney disease, requiring dialysis or a kidney transplant. Approximately 40% of individuals with SLE may develop lupus nephritis.
Voclosporin and Its Mechanism
Voclosporin, approved by the U.S. Food and Drug Administration (FDA) in January 2021 for adults with active lupus nephritis, is an oral medication. It belongs to a class of drugs known as calcineurin inhibitors (CNIs). These inhibitors work by suppressing the immune system, which is overactive in autoimmune conditions like lupus.
The mechanism of voclosporin involves blocking calcineurin, a protein that plays a role in activating T-cells, a type of white blood cell involved in immune responses. By inhibiting T-cell activation and cytokine production, voclosporin helps to reduce inflammation and damage in the kidneys. It also promotes the stability of kidney podocytes, specialized cells in the kidney’s filtering units, which helps improve kidney function and reduce protein levels in the urine.
Administering Voclosporin and What to Expect
Voclosporin is typically administered orally, usually taken twice daily. To ensure proper absorption, it should be taken on an empty stomach. The typical adult dosage for active lupus nephritis, when combined with other immunosuppressive therapies, is 23.7 mg twice daily.
Regular monitoring is an important part of voclosporin treatment to ensure its safety and effectiveness. This monitoring often includes blood tests to check kidney function, blood pressure, and voclosporin levels in the blood. Initially, kidney function may be assessed more frequently, with adjustments to monitoring schedules after the first year of treatment.
Individuals taking voclosporin may experience potential side effects, which can include decreased kidney function, elevated blood pressure, headaches, and urinary tract infections. Other reported side effects include diarrhea, fatigue, anemia, cough, abdominal pain, and mouth ulceration. Contact a healthcare provider if any concerning side effects occur, such as chest pain, irregular heart rate, or trouble breathing. Voclosporin is often used in combination with other medications for lupus nephritis, and vaccinations should be discussed with a doctor while on this treatment.
Voclosporin in Lupus Nephritis Treatment
Voclosporin plays a specific role within the comprehensive treatment strategy for lupus nephritis. It is generally used alongside established background immunosuppressive therapies, such as corticosteroids and mycophenolate mofetil. This combination approach leverages voclosporin’s targeted action.
Voclosporin provides a focused intervention against immune-mediated kidney damage. Clinical studies have indicated that patients receiving voclosporin in combination with standard care showed improved renal response rates and quicker reductions in urine protein levels. This helps achieve better kidney outcomes and higher rates of remission for patients.