The Expanding Lupus Pipeline: Obinutuzumab and What's Next, With Rosalind Ramsey-Goldman, MD

The treatment landscape for lupus nephritis has entered a period of rapid evolution, marked by a growing pipeline of targeted therapies and a renewed focus on reducing long-term toxicity while preserving organ function. For decades, clinicians relied on a limited set of broadly immunosuppressive options, often effective, but frequently associated with significant adverse effects, particularly from prolonged corticosteroid exposure. Recent years, however, have brought an expanding array of therapies designed specifically for lupus biology, reflecting deeper mechanistic understanding and a shift toward precision-driven care.

Against this backdrop, the recent United States Food and Drug Administration approval of obinutuzumab for lupus nephritis in October 2025 represented a major milestone for the field. The decision built on years of clinical investigation into B-cell–directed strategies and arrives at a time when both clinicians and patients are increasingly optimistic about what sustained innovation could mean for outcomes and quality of life. To better understand how these advances are resonating at the bedside, and what they signal for the future, we spoke with Rosalind Ramsey-Goldman, MD, Gallagher Research Professor of Rheumatology, Feinberg School of Medicine, Northwestern University, for her perspective seeing the rise of the biologic era and today’s expanding therapeutic toolkit.

Ramsey-Goldman reflected on how transformative the current moment is compared with earlier stages of her training, when only a handful of lupus therapies were available and many carried substantial risks. She emphasized that newer agents, including those targeting B-cell pathways, are enabling meaningful reductions in steroid use and moving care away from older, more toxic approaches. She also highlighted the unprecedented breadth of ongoing lupus research, with roughly 150 clinical trials actively recruiting, and a notable number of therapies already in late-stage development. While acknowledging that an influx of new therapies will require better strategies for comparative effectiveness and treatment selection, Ramsey-Goldman sees this as a good problem, underscoring how far the field has come from relying on off-label therapies toward drugs specifically designed, tested, and approved for lupus.

“There's lots of different choices, and we will have to understand… comparative effectiveness… And even if they're equivalent, at least you can say that right? There's so much individual variation in how people might respond to drugs, so if you have more than one choice, that's pretty good. It will be a challenge, but I would say that's good,” Ramsey-Goldman said.