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Objectives Combined immunosuppressive (ISU) therapy (at least two ISU drugs in addition to corticosteroid and/or antimalarial) is becoming the preferred strategy for the treatment of active lupus nephritis (LN). Real-life data on the recently approved LN therapies and the combination of these agents are limited so far. Our aim was to collect data on the practice of ISU combination in tertiary immunology centres in Hungary and to assess the efficacy of this therapeutic approach.Methods In collaboration of 5 academic immunology centres in Hungary, we retrospectively selected and analyzed the clinical course of lupus patients who were treated with a combination of at least 2 ISU agents for active LN for at least 6 months. Complete and partial renal response (CRR and PRR, respectively) were the primary outcomes.Results Sixty-six patients (52 females and 14 males, mean age: 36 years, range:17-66) were found to be eligible. ISU therapies were mycophenolate mofetil in 53, iv. cyclophosphamide in 8, rituximab in 25, belimumab in 16, obinutuzumab in 2, voclosporin in 21, tacrolimus in 6, cyclosporin-A in 4 and azathioprine in 3 patients. Six patients received triple ISU therapy. The mean duration of combined ISU therapy was 19 (range: 6-63) months. CRR was achieved in 37 (56%) and PRR in 16 (24%) patients, whereas 13 (20%) patients failed to achieve a therapeutic response. Forty-four of the patients are still on the combination therapy. In the remaining 22 patients, the reason for the termination was sustained remission in 10, inefficacy in 7, adverse event in 3 and non-adherence in 2 patients. The comparison of the results with those on standard ISU monotherapy (CYC or MMF) is under progress.Conclusions Combined ISU therapy is increasingly used as a favoured option for the treatment of LN in our centres. Renal response rates are high, and the combined therapy is suitable for long-term use with high patient retention rates.