Voclosporin (Calcineurin Inhibitor — Lupus Nephritis)

How it works

It inhibits calcineurin to suppress T-cell activation and cytokine production, and stabilises the podocyte cytoskeleton, reducing proteinuria.

Prescribing in practice

• Voclosporin is nephrotoxic and can raise blood pressure, so renal function and blood pressure must be monitored and the drug avoided or adjusted if eGFR falls significantly.
• It is metabolised by CYP3A4, so combination with strong CYP3A4 inhibitors is contraindicated and other interacting drugs require review per the SPC.
• Monitor for hyperkalaemia, QT considerations and infection, and use established immunosuppression precautions including infection screening.

Monitoring

Monitor renal function, blood pressure, serum potassium and signs of infection throughout treatment.

Counselling the patient

• Avoid grapefruit and tell your clinician about all other medicines you take.
• Attend for blood-pressure and kidney monitoring, and report any signs of infection.

Evidence & guidelines

Voclosporin added to standard therapy improved renal response in lupus nephritis in the randomised AURORA trial programme.