New opportunities for anti-B-cell therapy in lupus nephritis. Resolution of the expert council
A. M. Lila,
S. K. Solovyev,
E. A. Aseeva,
O. N. Anoshenkova,
E. A. Trofimov,
E. V. Zakharova,
N. L. Kozlovskaya,
E. S. Stolyarevich https://doi.org/10.14412/1996-7012-2026-1-140-144
Abstract
Lupus nephritis (LN) is one of the most common and clinically significant manifestations of systemic lupus erythematosus (SLE) and is associated with a high risk of disability. Delayed diagnosis of SLE in the Russian Federation and insufficient efficacy of standard treatment regimens necessitate the search for and implementation of new therapeutic approaches to improve patient outcomes. During the Expert Council meeting, current Russian and international clinical guidelines, data on the effectiveness of standard therapy, and the results of the international randomized phase III REGENCY clinical trial evaluating the efficacy and safety of obinutuzumab in patients with active LN were reviewed. The Expert Council resolution emphasizes that LN therapy requires a multidisciplinary approach. At the same time, the use of biologics, particularly obinutuzumab, opens new opportunities for achieving sustained remission, reducing glucocorticoid doses, and improving long-term prognosis in patients with highly active LN, including those with inadequate response to standard therapy.
Keywords
lupus nephritis,
systemic lupus erythematosus,
anti-B-cell therapy,
obinutuzumab,
complete renal response,
glucocorticoids
Supporting agencies: The article was prepared with the support of JSC Roche Moscow based on the outcomes of the Expert Council meeting “Modern approaches to the treatment of lupus nephritis: a dialogue between a rheumatologist and a nephrologist”, held on June 28, 2025, in Moscow.
About the Authors
A. M. Lila
V.A. Nasonova Research Institute of Rheumatology;
Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
Russian Federation
Russian Federation
4A, Kashirskoe Shosse, Moscow 115522, Russia;
2/1, Barrikadnaya Street, Build. 1, Moscow 125993, Russia
S. K. Solovyev
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
Russian Federation
4A, Kashirskoe Shosse, Moscow 115522, Russia
E. A. Aseeva
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
Russian Federation
Elena Alexandrovna Aseeva
4A, Kashirskoe Shosse, Moscow 115522, Russia
O. N. Anoshenkova
Tomsk Regional Clinical Hospital
Russian Federation
Russian Federation
96, Ivana Chernykh Street, Tomsk 634063, Russia
E. A. Trofimov
North-Western State Medical University named after I.I. Mechnikov, Ministry of Health of Russia
Russian Federation
Russian Federation
41, Kirochnaya Street, Saint Petersburg 191015, Russia
E. V. Zakharova
Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia;
S.P. Botkin Moscow Multidisciplinary Scientific and Clinical Center, Moscow Healthcare Department
Russian Federation
Russian Federation
2/1, Barrikadnaya Street, Build. 1, Moscow 125993, Russia
5, 2nd Botkinsky Proezd, Moscow 125284, Russia
N. L. Kozlovskaya
RUDN University;
A.K. Eramishantsev City Clinical Hospital, Moscow Healthcare Department
Russian Federation
Russian Federation
6, Miklukho-Maklaya Street, Moscow 117198, Russia;
15, Lenskaya Street, Moscow 129327, Russia
E. S. Stolyarevich
Moscow Clinical Research Center, Hospital №52, Moscow Healthcare Department
Russian Federation
Russian Federation
3, Pekhotnaya Street, Moscow 123182, Russia
References
1. Aseeva EA, Lila AM, Solovev SK, et al. Lupus nephritis as a special clinical and immunological phenotype of systemic lupus erythematosus. Modern Rheumatology Journal. 2022; 16(6):12-19. (In Russ.). doi: 10.14412/1996-7012-2022-6-12-19.
2. Popkova TV, Panafidina TA, Lila AM. Methodological recommendations (draft). Systemic lupus erythematosus: diagnosis, treatment, monitoring (abbreviated version). Terapiya.2025;(1): 8-15. (In Russ.).
3. Solovyev SK, Kozlovskaya NL, Aseeva EA, et al. Lupus nephritis – modern aspects of diagnosis and therapy. Part I. Rheumatology Science and Practice. 2024;62(1):55-64. (In Russ.) doi:10.47360/1995-4484-2024-55-64
4. Sterlikov SA, Zelenova OV, Abramov SI. Epidemiology of systemic lupus erythematosus in the Russian Federation (incidence, prevalence, and spatial heterogeneity of indicators). Diagnosticheskaya i interventsionnaya radiologiya. 2024;18(5):38-45. (in Russ.).
5. Kidney Disease: Improving Global Outcomes (KDIGO) Lupus Nephritis Work Group. KDIGO 2024 Clinical Practice Guideline for the management of LUPUS NEPHRITIS. Kidney Int. 2024 Jan;105(1S): S1-S69. doi: 10.1016/j.kint.2023.09.002.
6. Van Vollenhoven RF, Mosca M, Bertsias G, et al. Treat-to-target in systemic lupus erythematosus: recommendations from an international task force. Ann Rheum Dis. 2014 Jun;73(6):958-67. doi: 10.1136/annrheumdis-2013-205139.
7. Fanouriakis A, Kostopoulou M, Anders HJ, et al. EULAR recommendations for the management of systemic lupus erythematosus with kidney involvement: 2025 update. Ann Rheum Dis. 2025 Oct 16:S0003-4967(25)04412-7. doi: 10.1016/j.ard.2025.09.007.
8. Izmirly PM, Kim MY, Carlucci PM, et al. Longitudinal patterns and predictors of response to standard-of-care therapy in lupus nephritis: data from the Accelerating Medicines Partnership Lupus Network. Arthritis Res Ther. 2024 Feb 20;26(1):54. doi: 10.1186/s13075-024-03275
9. https://www.frontiersin.org/journals/lupus/articles/10.3389/flupu.2024.1334932/full
10. Luis MSF, Bultink IEM, da Silva JAP, et al. Early predictors of renal outcome in patients with proliferative lupus nephritis: a 36-month cohort study. Rheumatology (Oxford). 2021 Nov 3;60(11):5134-5141. doi: 10.1093/rheumatology/keab126.
11. Moroni G, Quaglini S, Gallelli B, et al. The long-term outcome of 93 patients with proliferative lupus nephritis. Nephrol Dial Transplant. 2007 Sep;22(9):2531-9. doi: 10.1093/ndt/gfm245.
12. Aseeva EA, Amirdzhanova VN, Lisitsina TA, Zavalskaya MV. Quality of life in patients with systemic lupus erythematosus. Nauchno-prakticheskaya revmatologiya. 2013;51(3):324-331. (In Russ.).
13. Chrysostomou C, Faustini F, Gunnarsson I, et al. Long-term Outcomes of Lupus Nephritis in Comparison to Other CKD Etiologies. Kidney Int Rep. 2024 Oct 28; 10(1):157-168. doi: 10.1016/j.ekir.2024.10.021.
14. Vorobeva LD, Aseeva EA. The importance of health-related quality of life in patients with systemic lupus erythematosus and modern tools for its assessment. Modern Rheumatology Journal. 2017;11(4):62-72. (In Russ.). doi: 10.14412/1996-7012-2017-4-62-72.
15. Kattah AG, Garovic VD. Pregnancy and Lupus Nephritis. Semin Nephrol. 2015 Sep; 35(5):487-99. doi: 10.1016/j.semnephrol.2015.08.010.
16. Moroni G, Doria A, Giglio E, et al. Maternal outcome in pregnant women with lupus nephritis. A prospective multicenter study. J Autoimmun. 2016 Nov;74:194-200. doi: 10.1016/j.jaut.2016.06.012.
17. Schramm AM, Clowse ME. Aspirin for prevention of preeclampsia in lupus pregnancy. Autoimmune Dis. 2014;2014:920467. doi: 10.1155/2014/920467.
18. Hladunewich MA, Bramham K, Jim B, Maynard S. Managing glomerular disease in pregnancy. Nephrol Dial Transplant. 2017 Jan 1;32(suppl_1):i48-i56. doi: 10.1093/ndt/gfw319.
19. Cabiddu G, Longhitano E, Cataldo E, et al. History of Preeclampsia in Patients Undergoing a Kidney Biopsy: A Biphasic, Multiple-Hit Pathogenic Hypothesis. Kidney Int Rep. 2021 Dec 17;7(3):547-557. doi: 10.1016/j.ekir.2021.12.014.
20. Lila AM, Trofimov EA, Lila VA. Systemic lupus erythematosus: features of the course in pregnant women and treatment options. Modern Rheumatology Journal. 2015;9(3):43-47 (In Russ.). doi: 10.14412/1996-7012-2015-3-43-47.
21. Singh AG, Chowdhary VR. Pregnancy-related issues in women with systemic lupus erythematosus. Int J Rheum Dis. 2015 Feb;18(2): 172-81. doi: 10.1111/1756-185X.12524.
22. Moroni G, Doria A, Giglio E, et al. Fetal outcome and recommendations of pregnancies in lupus nephritis in the 21st century. A prospective multicenter study. J Autoimmun. 2016 Nov;74:6-12. doi: 10.1016/j.jaut.2016.07.010.
23. Rovin BH, Furie R, Latinis K, et al. Efficacy and safety of rituximab in patients with active proliferative lupus nephritis: the Lupus Nephritis Assessment with Rituximab study. Arthritis Rheum. 2012 Apr;64(4):1215-26. doi: 10.1002/art.34359.
24. Aseeva EA, Solovev SK, Mesnyankina AA, et al. The experience of using belimumab in patients with systemic lupus erythematosus. Nauchno-prakticheskaya revmatologiya. 2015; 53(3):329-335. (In Russ.).
25. Bolotova EV, Yakovleva EV, Ilinyh EK, Rassovskaya TA. The experience of using anifrolumab in the treatment of patients with systemic lupus erythematosus. Nauchno-prakticheskaya revmatologiya. 2025;63(1):64-69. (In Russ.).
26. Lyu X, Gupta L, Tholouli E, Chinoy H. Chimeric antigen receptor T cell therapy: a new emerging landscape in autoimmune rheumatic diseases. Rheumatology (Oxford). 2024 May 2;63(5):1206-1216. doi: 10.1093/rheumatology/kead616.
27. Furie R, Rovin BH, Houssiau F, et al. Two-Year, Randomized, Controlled Trial of Belimumab in Lupus Nephritis. N Engl J Med. 2020 Sep 17;383(12):1117-1128. doi: 10.1056/NEJMoa2001180.
28. Rovin BH, Furie R, Teng YKO, et al. A secondary analysis of the Belimumab International Study in Lupus Nephritis trial examined effects of belimumab on kidney outcomes and preservation of kidney function in patients with lupus nephritis. Kidney Int. 2022 Feb;101(2):403-413. doi: 10.1016/j.kint.2021.08.027.
29. Furie RA, Rovin BH, Garg JP, et al. Efficacy and Safety of Obinutuzumab in Active Lupus Nephritis. N Engl J Med. 2025 Apr 17;392(15):1471-1483. doi: 10.1056/NEJMoa2410965.
30. Reddy V, Klein C, Isenberg DA, et al. Obinutuzumab induces superior B-cell cytotoxicity to rituximab in rheumatoid arthritis and systemic lupus erythematosus patient samples. Rheumatology (Oxford). 2017 Jul 1; 56(7):1227-1237. doi: 10.1093/rheumatology/kex067.
31. Furie RA, Aroca G, Cascino MD. B-cell depletion with obinutuzumab for the treatment of proliferative lupus nephritis: a randomised, double-blind, placebo-controlled trial. Ann Rheum Dis. 2022 Jan;81(1):100-107. doi: 10.1136/annrheumdis-2021-220920.
32. Al-Sawaf O, Fischer K, Engelke A, et al. Obinutuzumab in chronic lymphocytic leukemia: design, development and place in therapy. Drug Des Devel Ther. 2017 Jan 25; 11:295-304. doi: 10.2147/DDDT.S104869.
33. Klein C, Lammens A, Schäfer W, et al. Epitope interactions of monoclonal antibodies targeting CD20 and their relationship to functional properties. MAbs. 2013 Jan-Feb;5(1): 22-33. doi: 10.4161/mabs.22771.
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For citations:
Lila AM, Solovyev SK, Aseeva EA, Anoshenkova ON, Trofimov EA, Zakharova EV, Kozlovskaya NL, Stolyarevich ES. New opportunities for anti-B-cell therapy in lupus nephritis. Resolution of the expert council. Sovremennaya Revmatologiya=Modern Rheumatology Journal. 2026;20(1):140-144. (In Russ.) https://doi.org/10.14412/1996-7012-2026-1-140-144
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