Daratumumab to Treat Active Lupus Nephritis

Prior treatment

• Patients receiving \> 10 mg of oral prednisone or glucocorticoid equivalent if on corticosteroids for \> 2 weeks (patients would be allowed to be on \> 10 mg of prednisone or its oral equivalent as long as the duration is ≤ 2 weeks).
• Patients who had received immunosuppressive therapy including cyclosporine, tacrolimus or azathioprine in the last 3 months.
• Patients who have received cyclophosphamide in the last 6 months.

Other illness

• Hepatitis B or C, HIV
• For women who are not postmenopausal (≥ 12 months of non-therapy-induced amenorrhea) or surgically sterile (absence of ovaries and/or uterus): agreement to remain abstinent or use two adequate methods of contraception, including at least one method with a failure rate of less than (\<) 1 percent (%) per year, during the treatment period and for at least 12 months after the last dose of study drug.
• For men: agreement to remain abstinent or use a condom plus an additional contraceptive method that together result in a failure rate of \< 1% per year during the treatment period and for at least 12 months after the last dose of study drug and agreement to refrain from donating sperm during this same period.

Lab values

• Anemia with Hgb \< 8.0 g/dL.
• Thrombocytopenia with platelet count \< 100'000.
• Any other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug or that may affect the interpretation of the results or render the patient at high risk from treatment complication.
• Patients who received rituximab previously with CD20 count of zero at the time of enrollment.

Other

• Pregnancy.
• Unable to provide consent.
• Patient are allowed to be on MMF at time of enrollment but no higher than total of 1500mg/day.
• Patients with diagnosis of glaucoma.

• Age ≥ 18 years of age.
• Diagnosis of SLE according to current American College of Rheumatology (ACR) criteria.
• Renal biopsy confirming the diagnosis of active class III/IV (± class V) LN (based on International Society of Nephrology/Renal Pathology Society (ISN/RPS) 2003) within 12 months of enrollment.
• Proteinuria ≥ 500 mg over 24 hours.
• eGFR ≥ 30 ml/min/SA.
• Subjects should be able to give informed consent.