FAQ: What Are CNIs? Treating Lupus Nephritis with the Latest ACR Guidelines

In this video, Lisa Asfahani, PA-C, shares clinical insights on the evolving role of calcineurin inhibitors (CNIs) in the treatment of lupus nephritis (LN), as outlined in the new 2024 ACR Guidelines. With over 11 years of experience in rheumatology at a private practice in Temecula, California, Lisa walks through the mechanism of action of CNIs—including how they inhibit IL-2 production by binding to cytoplasmic receptors like immunophilins, ultimately suppressing T-cell activity.She discusses common CNIs used in clinical practice, such as tacrolimus, cyclosporine, and the newer agent voclosporin. Voclosporin, in particular, is highlighted for its role in treating LN, including recommended dosing guidelines and considerations for renal or hepatic impairment.Lisa also breaks down how CNIs fit into the updated 2024 ACR treatment algorithm for lupus nephritis. Triple therapy, which now includes a CNI, is recommended for Class III and IV LN. Class V LN patients should be treated with a glucocorticoid, mycophenolate, and a CNI.Whether you're a clinician looking to stay current with treatment strategies or an APP diving deeper into rheumatology therapies, this video offers a concise overview of how CNIs are shaping modern LN management. Visit RhAPP.org or download the RhAPP ACE App for more insightful and educational information.