Voclosporin

How it works

It inhibits calcineurin, suppressing T-lymphocyte activation and interleukin-2 production, and stabilises the podocyte to reduce proteinuria. This dampens the immune-mediated glomerular injury of lupus nephritis.

Prescribing in practice

• As a calcineurin inhibitor it is nephrotoxic and can raise blood pressure and serum potassium, so renal function must be assessed at baseline and during treatment and the drug reduced or stopped if eGFR falls — this is the key safety point.
• It is contraindicated or requires dose reduction with strong CYP3A4 inhibitors and should not be used with the higher-exposure dosing in significant baseline renal impairment.
• Monitor for QT prolongation and avoid combination with other potently QT-prolonging agents.

Monitoring

Monitor eGFR, blood pressure and serum potassium at baseline and regularly during therapy, with dose adjustment driven by renal function.

Counselling the patient

• Have your kidney function and blood pressure checked as scheduled.
• Avoid grapefruit and tell your doctor about new medicines that may interact.
• Report swelling, reduced urine output or palpitations.

Evidence & guidelines

The AURORA trials demonstrated that adding voclosporin to standard therapy improves renal response rates in lupus nephritis, supporting its approved combination use.