From the Guidelines
Obinutuzumab should be considered as a treatment option for lupus nephritis, as it has shown to improve complete renal response rates compared to standard therapy alone, with 35% of patients achieving complete response at 52 weeks and 41% at 104 weeks, compared to 23% in the placebo group 1. The use of obinutuzumab in lupus nephritis is based on its mechanism of action as a humanized type 2 anti-CD20 monoclonal antibody, which targets and depletes B cells, playing a key role in the pathogenesis of lupus nephritis by producing autoantibodies and promoting inflammation. Some key points to consider when using obinutuzumab for lupus nephritis include:
- Obinutuzumab is administered in addition to mycophenolate mofetil (MMF) and glucocorticoids (GCs) 1
- The efficacy of obinutuzumab was demonstrated in a randomized controlled trial, with a significant improvement in complete renal response rates compared to placebo 1
- Common side effects of obinutuzumab include infusion reactions, infections, and neutropenia, and patients should receive appropriate premedication before infusions and be monitored for infections 1
- The use of obinutuzumab should be considered primarily in the context of clinical trials or for patients with severe disease who have failed standard treatments, due to its investigational status for lupus nephritis 1
From the Research
Role of Obinutizumab in Lupus Nephritis
- Obinutuzumab, a humanized type II anti-CD20 monoclonal antibody, has been shown to provide significantly better renal responses than placebo in patients with lupus nephritis receiving standard therapy 2.
- In a phase 3, randomized, controlled trial, obinutuzumab plus standard therapy was more efficacious than standard therapy alone in providing a complete renal response, with 46.4% of patients in the obinutuzumab group achieving a complete renal response at week 76, compared to 33.1% in the placebo group 2.
- The use of obinutuzumab in lupus nephritis is supported by its ability to target autoimmune responses and inflammatory pathways, bringing hope to the treatment of intractable lupus 3.
Comparison with Other Treatments
- Rituximab, another monoclonal antibody targeting CD20, has been considered a novel therapeutic option for the management of SLE, with some studies showing its effectiveness in patients with resistant lupus nephritis 4, 5.
- However, the role of rituximab in lupus nephritis is still problematic, with completed trials being negative despite clinical experience suggesting efficacy 5.
- The use of glucocorticoids, a cornerstone in the treatment of SLE, including lupus nephritis, has been questioned due to their severe side effects, and there is a need to develop steroid-sparing treatment regimens 6.
Efficacy and Safety of Obinutuzumab
- Obinutuzumab has been shown to be effective in providing a complete renal response, with a significant decline in 24-hour urine protein, and improvement in renal function 2.
- However, more serious adverse events, mainly infections and events related to coronavirus disease 2019, occurred with obinutuzumab than with placebo 2.
- The safety profile of obinutuzumab is still being monitored, and further studies are needed to fully understand its efficacy and safety in patients with lupus nephritis.