Roger A Levy, MD, PhD: The Paradigm Shift in Lupus Nephritis Management

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Roger A Levy, MD, PhD, discusses the transformative impact of the KDIGO guidelines, which recommend early initiation of belimumab for lupus nephritis.

In an interview with HCPLive, Roger A Levy, MD, PhD, senior global medical director at GSK Specialty Medicine, discussed the recent Kidney Disease: Improving Global Outcomes (KDIGO) clinical guideline updates for the management of lupus nephritis. Among these updates, the organization recommends early initiation of belimumab for the treatment of this condition.

Levy believes these guidelines represent a paradigm shift because, previously, non-selective immune suppressors, similar to those used in oncology but at lower doses and for extended durations, were prescribed. While this approach showed improvements compared to steroids alone, it still posed risks including increased infections, bone marrow depletion, and ovarian failure. By introducing belimumab early and incorporating it into a more extended maintenance period, clinicians can mitigate exposure to steroids, thus reducing associated side effects and minimizing the risk of damage and relapses.

The impact is significant as it standardizes practices for clinicians, payers, and authorities, ensuring evidence-based clinical practices. This benefits patients and their families by endorsing effective treatments, which can potentially lower the incidence of lupus patients progressing to end-stage kidney disease, needing dialysis, or transplantation.

While it marks a crucial beginning in targeted therapy tailored to specific cytokines, recognizing the diverse nature of lupus requires ongoing research into new targets for a more comprehensive understanding of the disease mechanism and improved patient outcomes.

“We are learning more about the disease mechanism,” Levy stated. “And knowing how to break this chain that, if we let [continue], would be continuously causing damage. We know that the damage, when present, predicts further damage and early mortality. So, we want to avoid that. We want our patients to live longer and with a better quality of life.”

Levy is especially grateful to the patients, their families, and healthcare providers involved in these studies.

“It takes more than a village and it's a lot of effort,” Levy explained. “If we didn't have those people volunteering to be on the trial and the support from their families and the whole healthcare team involved, we wouldn't be offering people living with lupus better options for treatment.”

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