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Voclosporin in Lupus Nephritis — SCE Rheumatology MCQ

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HardRheumatology PharmacologyVoclosporin in Lupus NephritisSCE Rheumatology

A patient with lupus nephritis starts voclosporin with mycophenolate. Baseline eGFR is 70 mL/min/1.73 m²; two repeat measurements within 48 hours are 48 and 47. What dose action does the UK SmPC require?

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Reveal the answer and explanation

Correct answer: B — Stop voclosporin, then restart at 7.9 mg twice daily after eGFR recovery

Explanation lettering: E = shown as A · D = shown as B · B = shown as C · C = shown as D · A = shown as E

D is correct. The confirmed fall exceeds 30% from baseline, so voclosporin is stopped. If renal function recovers, the SmPC permits reduced-dose restart at 7.9 mg twice daily with cautious re-escalation. A ignores the percentage-change rule. B is the action for a confirmed fall greater than 20% but below 30%. C is not an authorised renal-adjustment schedule. E targets the companion drug rather than the calcineurin-inhibitor haemodynamic toxicity.

Reference: Lupkynis 7.9 mg capsules — UK SmPC: https://www.medicines.org.uk/emc/product/14381/smpc