title: Mizoribine, tacrolimus, and corticosteroid combination therapy successfully induces remission in patients with lupus nephritis.
abstract: BACKGROUND
  Conventional cyclophosphamide-based treatment regimens for lupus nephritis (LN) are still not considered to be optimal. The aim of this study was to evaluate the efficacy and safety of mizoribine, tacrolimus, and corticosteroid combination therapy for LN.
  
  
  METHODS
  We retrospectively evaluated a combination treatment of mizoribine and tacrolimus with corticosteroids as induction therapy in eight newly diagnosed systemic lupus erythematosus (SLE) patients with biopsy-proven LN.
  
  
  RESULTS
  All patients were women, and their mean [standard deviation (SD)] age was 48.5 (20) years. All patients (100 %) had positive anti-double-stranded DNA (anti-dsDNA) antibody titers, and four (50.0 %) were nephrotic. Mean (SD) serum creatinine and daily proteinuria levels were 0.72 (0.4) mg/dl (range 0.33-1.55 mg/dl) and 4.56 (2.8) g (range 0.77-8.2 g), respectively. By month 2, significant improvements in the anti-dsDNA antibody titers, levels of proteinuria, serum albumin, and C3, and SLE disease activity index score were observed. By month 6, seven patients (87.5 %) were in complete remission, with normalized levels of both proteinuria and serum creatinine.
  
  
  CONCLUSIONS
  This pilot study suggests that mizoribine and tacrolimus treatment with corticosteroids is well tolerated and may prove to be an optimal alternative remission-inducing regimen for LN.
authors.affiliation: Department of Internal Medicine, Himeji Red Cross Hospital, 1-12-1 Shimoteno, Himeji 670-8540, Japan. k-river@hrc-hp.com
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Kagawa
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Hiromasa
authors.forename: Takayuki
authors.initials: T
authors.lastname: Hara
authors.forename: Ayako
authors.initials: A
authors.lastname: Takaki
authors.forename: Ryutaro
authors.initials: R
authors.lastname: Yamanaka
authors.forename: Ken-ei
authors.initials: KE
authors.lastname: Sada
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Makino
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D003404:Creatinine / Q000097:blood; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy*; D008181:Lupus Nephritis / Q000188:drug therapy*; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D010865:Pilot Projects; D011239:Prednisolone / Q000627:therapeutic use; D011507:Proteinuria / Q000188:drug therapy; D012074:Remission Induction; D012189:Retrospective Studies; D012263:Ribonucleosides / Q000627:therapeutic use*; D016559:Tacrolimus / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D012263:Ribonucleosides; C010052:mizoribine; D011239:Prednisolone; D003404:Creatinine; D016559:Tacrolimus; D008775:Methylprednisolone