Recent news in the treatment of lupus nephritis.
Patient survival and renal survival of patients with lupus nephritis improved, but still in a significant proportion of patients the disease progresses to end-stage renal failure, possibly at least partly due to slow and incomplete response to induction treatment and high relapse rate on the maintenance treatment. Mycophenolate mofetil was recently demonstrated to be a comparably effective and safe induction treatment of lupus nephritis as high-dose cyclophosphamide pulses, in Caucasian patients it has become a reasonable alternative to low-dose cyclophosphamide pulses according to the EUROLUPUS protocol. Mycophenolate was shown to be more effective than azathioprine in the maintenance treatment and is currently the treatment of choice for this phase of the disease. Rituximab should be reserved for patients refractory (or intolerant) to cyclophosphamide and/or mycophenolate. Therapy of lupus nephritis should be individually tailored; more aggressive therapy should be reserved for patients at high risk for renal dysfunction and its progression.
Department of Nephrology, 1st School of Medicine and General University Hospital, Charles University, Prague, Czech Republic. vladimir.tesar @vfn.cz
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D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D001379:Azathioprine / Q000627:therapeutic use; D065095:Calcineurin Inhibitors; D002986:Clinical Trials as Topic; D003520:Cyclophosphamide / Q000627:therapeutic use*; D018450:Disease Progression; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D060828:Induction Chemotherapy / Q000379:methods; D007676:Kidney Failure, Chronic / Q000209:etiology; D008181:Lupus Nephritis / Q000150:complications / Q000188:drug therapy*; D060046:Maintenance Chemotherapy / Q000379:methods; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000069283:Rituximab
D058846:Antibodies, Monoclonal, Murine-Derived; D065095:Calcineurin Inhibitors; D004791:Enzyme Inhibitors; D007166:Immunosuppressive Agents; D000069283:Rituximab; D003520:Cyclophosphamide; D009173:Mycophenolic Acid; D001379:Azathioprine