Voclosporin Treatment of Proliferative Lupus Nephritis in Childhood, a Case Report

Abstract Lupus nephritis (LN) occurs frequently in children with systemic lupus erythematosus (SLE) and contributes significantly to morbidity and mortality. Remission rates with current approved treatments remain suboptimal. Voclosporin is a new calcineurin inhibitor (CNI) with trials in adult patients revealing earlier and greater reductions in proteinuria and few adverse events. Here, we present the use of voclosporin in two pediatric patients with proliferative LN. The first patient is a 15-year-old female, with new onset SLE, with biopsy confirmed Class IV LN. She was treated with steroids, mycophenolate mofetil (MMF), lisinopril, hydroxychloroquine, and voclosporin. Proteinuria improved to near normal 2 months post initiation and the steroids were able to be rapidly tapered and discontinued. Repeat kidney biopsy 10 months post-diagnosis revealed complete resolution of active disease with no histological CNI adverse effects. The second patient is a 12-year-old female who presented with SLE, macrophage activating syndrome, and sepsis. A kidney biopsy performed 6 weeks post presentation revealed Class IV LN and she was treated with steroids, MMF and belimumab. Voclosporin was exchanged for belimumab 1.5 months later, and one month after starting voclosporin proteinuria had resolved, steroids were tapered and discontinued. In these 2 pediatric patients, voclosporin was safe, effective and allowed a rapid taper of steroids.