Kidney Outcomes and Preservation of Kidney Function With Obinutuzumab in Patients With Lupus Nephritis: A Post Hoc Analysis of the NOBILITY Trial.
In a post hoc analysis of the phase II NOBILITY trial, adding obinutuzumab to standard lupus nephritis therapy resulted in superior preservation of kidney function and fewer flares, with more patients achieving complete renal response while using less glucocorticoid.
Study design
Post hoc analyses of the phase II NOBILITY trial compared patients with active lupus nephritis randomized to obinutuzumab (n=63) or placebo (n=62), both in combination with mycophenolate mofetil and glucocorticoids. Outcomes assessed included time to an unfavorable kidney outcome (composite of treatment failure, doubling of serum creatinine, or death), lupus nephritis flare, first 30% and 40% declines in eGFR from baseline, chronic eGFR slope, and complete renal response (CRR) achieved on 7.5 mg or less per day of prednisone.
Key findings
Obinutuzumab reduced the risk of the composite kidney outcome by 60%, lupus nephritis flare by 57%, and the first eGFR decline of 30% or 40% by 80% and 91%, respectively. Patients receiving obinutuzumab had a significantly slower decline in eGFR, with an annualized eGFR slope advantage of 4.1 ml/min/1.73 m2/year (95% CI 0.14-8.08). At week 76, 38% of obinutuzumab patients versus 16% of placebo patients achieved CRR while receiving 7.5 mg or less per day of prednisone (P<0.01); at week 104 the difference (38% vs 22%) did not reach significance (P=0.06).
Clinical implications
These post hoc analyses demonstrated that, compared with standard-of-care therapy, obinutuzumab treatment resulted in superior preservation of kidney function and prevention of lupus nephritis flares, with more patients achieving complete renal response at week 76 while using less glucocorticoid.
Category
Research
Source
Arthritis Rheumatol
More from ASNRT News
Browse the latest news, society announcements, KDIGO guideline updates, and AJNT issue releases on the ASNRT newsroom.