title: Efficacy of mizoribine-tacrolimus-based induction therapy for pediatric lupus nephritis.
abstract: BACKGROUND
  Recent advances in the management of lupus nephritis (LN) have also contributed to a favorable outcome in patients with pediatric-onset LN. Nevertheless, we believe that a more effective and less toxic treatment is needed to attain optimal control of pediatric-onset LN.
  
  
  METHODS
  Seven consecutive children with biopsy-proven LN (four with class III/IV and three with class V) received multitarget induction therapy consisting of mizoribine (MZR), tacrolimus (Tac), and prednisolone (PDN). They were prospectively evaluated at three, six, and 12 months, and at the latest observation point after a mean period of 32 months. Post-treatment renal biopsy was performed in two patients with class III/IV.
  
  
  RESULTS
  Despite gradually tapering the dose of concomitantly administered PDN, a significant improvement compared with baseline values was observed in the urinary, serological, and clinical assessment measures even at three months of treatment, and the favorable changes persisted throughout the treatment period in most of the study participants except for one. In two patients who underwent post-treatment renal biopsy, a marked histologic improvement was confirmed. No serious adverse events were observed.
  
  
  CONCLUSIONS
  Multitarget therapy may be an attractive option for the treatment of pediatric-onset LN. Further studies involving a larger number of patients are needed.
authors.affiliation: Department of Pediatrics, Hirosaki University Hospital Department of School Health Science, Faculty of Education, Hirosaki University hirotana@cc.hirosaki-u.ac.jp.
authors.forename: H
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: Department of Pediatrics, Hirosaki University Hospital.
authors.forename: T
authors.initials: T
authors.lastname: Aizawa
authors.affiliation: Department of Pediatrics, Hirosaki University Hospital.
authors.forename: S
authors.initials: S
authors.lastname: Watanabe
authors.affiliation: Department of Pediatrics, Hirosaki University Hospital.
authors.forename: E
authors.initials: E
authors.lastname: Oki
authors.affiliation: Department of Pediatrics, Hirosaki University Hospital.
authors.forename: K
authors.initials: K
authors.lastname: Tsuruga
authors.affiliation: Department of Vascular Biology, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Imaizumi
mesh_terms: D000293:Adolescent; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D060828:Induction Chemotherapy; D008181:Lupus Nephritis / Q000188:drug therapy*; D008297:Male; D010865:Pilot Projects; D011239:Prednisolone / Q000008:administration & dosage*; D011446:Prospective Studies; D012263:Ribonucleosides / Q000008:administration & dosage*; D016559:Tacrolimus / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D012263:Ribonucleosides; C010052:mizoribine; D011239:Prednisolone; D016559:Tacrolimus
keywords: Lupus nephritis; mizoribine; multitarget therapy; pediatric-onset; systemic lupus erythematosus; tacrolimus