title: Tacrolimus is an effective treatment for lupus nephritis in pregnancy.
abstract: Lupus nephritis during pregnancy increases morbidity and mortality for mother and baby. Flares are difficult to treat as many therapeutic options are teratogenic or fetotoxic. Steroids alone may be unable to control disease activity and are associated with higher rates of preterm delivery, sepsis and gestational diabetes. Reports of using tacrolimus to treat lupus nephritis in pregnancy are limited. We describe the pregnancies of nine women in whom tacrolimus was successfully used to treat lupus nephritis flare (six patients) or maintain stable disease (three patients). Introduction or dose escalation of oral steroids was avoided in five of the patients who developed active disease and steroid dose was rapidly reduced in the sixth patient. All women with disease flare attained partial or complete remission after starting tacrolimus. None of the women on maintenance treatment developed active disease. We propose tacrolimus as an effective adjuvant or alternative therapy to steroids for treating lupus nephritis flare or maintaining stable disease during pregnancy.
authors.affiliation: Imperial College Healthcare NHS Trust Lupus Centre, Hammersmith Hospital, London, UK p.webster@imperial.ac.uk.
authors.forename: P
authors.initials: P
authors.lastname: Webster
authors.affiliation: Imperial College Healthcare NHS Trust Lupus Centre, Hammersmith Hospital, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Wardle
authors.affiliation: Division of Women's Healthy, Women's Health Academic Centre, King's College London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Bramham
authors.affiliation: Division of Women's Healthy, Women's Health Academic Centre, King's College London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Webster
authors.affiliation: Division of Women's Healthy, Women's Health Academic Centre, King's College London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Nelson-Piercy
authors.affiliation: Imperial College Healthcare NHS Trust Lupus Centre, Hammersmith Hospital, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Lightstone
mesh_terms: D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008181:Lupus Nephritis / Q000188:drug therapy* / Q000503:physiopathology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000503:physiopathology; D016559:Tacrolimus / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus
keywords: Lupus nephritis; pregnancy; tacrolimus