A case of lupus nephritis achieving early remission using a treatment protocol similar to the AURORA trial with voclosporin and successfully discontinuing corticosteroids early.

Lupus nephritis (LN) is characterized by immune system attacks on self-tissues, triggered by the production of pathological autoantibodies, leading to damage in multiple organs and tissues throughout the body. The second-generation calcineurin inhibitor, voclosporin, has recently been recommended in guidelines as an adjunct to basic immunosuppressive interventions for managing active LN in adult patients. However, there are still no real-world data showing that remission was achieved by administering voclosporin in LN using the same protocol as the AURORA trial. We report the case of a 19-year-old woman with proteinuria and microscopic hematuria. The patient developed nephrotic syndrome three years prior to presentation to our department and achieved complete remission with corticosteroids. In the year of presentation, hypocomplementemia and anti-ds-DNA antibodies were detected. Renal biopsy revealed a thickened glomerular basement membrane with spike formation, granular C1q deposition in the mesangial regions, and high electron-density deposits on the epithelial side of the basement membrane. The patient was diagnosed with LN (ISN V) and started treatment with voclosporin combined with corticosteroids, hydroxychloroquine, and mycophenolate mofetil to decrease corticosteroids, which was similar to the regimen as in the AURORA study. Complete remission was achieved 30 days after treatment initiation, and the corticosteroids were discontinued 25 weeks after treatment initiation. This study represents the first clinical case report demonstrating complete remission of LN achieved by implementing the AURORA regimen.