title: Efficacy and safety of multi-target therapy using a combination of tacrolimus, mycophenolate mofetil and a steroid in patients with active lupus nephritis.
abstract: OBJECTIVE
  To examine the efficacy and safety of multi-target therapy using tacrolimus (TAC), mycophenolate mofetil (MMF) and a steroid as initial treatment for active lupus nephritis (LN).
  
  
  METHODS
  We conducted a retrospective analysis of the data of 16 consecutive patients who received the multi-target therapy for active Classes III-V LN at our department. We also compared the outcomes of the multi-target therapy with those of TAC therapy (TAC + steroid), a study of which we had conducted previously in 13 patients with active LN (TAC group).
  
  
  RESULTS
  All the patients treated with multi-target therapy achieved complete remission (CR) (mean, 4.6 ± 3.8 months; range, 1-15 months). The clinical profiles of the patients of the multi-target group were similar to those of the TAC group at baseline, except for a significantly higher level of proteinuria (4.6 ± 2.8 vs. 2.5 ± 2.1 g/gCr, p = 0.033) in the former. The CR rate at 6 months was significantly higher in the multi-target group as compared with that in the TAC group (81% vs. 38%, p = 0.018). Two cases of serious adverse events were associated with cytomegalovirus infection in the multi-target group, namely gastric ulcer and pancytopenia, both of which were successfully treated by antiviral therapy.
  
  
  CONCLUSIONS
  Multi-target therapy was effective as initial treatment for active LN, with CR achieved early and in a high percentage of patients. Although this therapy was generally well tolerated, it is important to bear in mind the associated risk of cytomegalovirus infection.
authors.affiliation: Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine , Maebashi , Japan.
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Ikeuchi
authors.forename: Keiju
authors.initials: K
authors.lastname: Hiromura
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takahashi
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Mishima
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Sakurai
authors.forename: Toru
authors.initials: T
authors.lastname: Sakairi
authors.forename: Yoriaki
authors.initials: Y
authors.lastname: Kaneko
authors.forename: Akito
authors.initials: A
authors.lastname: Maeshima
authors.forename: Takashi
authors.initials: T
authors.lastname: Kuroiwa
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nojima
mesh_terms: D000328:Adult; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008181:Lupus Nephritis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011239:Prednisolone / Q000009:adverse effects / Q000627:therapeutic use*; D012074:Remission Induction; D012189:Retrospective Studies; D016559:Tacrolimus / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D011239:Prednisolone; D009173:Mycophenolic Acid; D016559:Tacrolimus
keywords: Immunosuppressive therapy; Lupus nephritis; Multi-target therapy; Mycophenolate mofetil; Systemic lupus erythematosus; Tacrolimus