title: Towards new avenues in the management of lupus glomerulonephritis.
abstract: Renal involvement in systemic lupus erythematosus (SLE) carries substantial morbidity and mortality. Conventional immunosuppressive agents (cyclophosphamide and azathioprine) have suboptimal efficacy and substantial toxicity. Mycophenolate mofetil has emerged as an alternative agent for both induction and maintenance therapy in lupus nephritis because of its reduced gonadal toxicity, despite its failure to demonstrate superiority over cyclophosphamide in pivotal studies. The calcineurin inhibitor tacrolimus has equivalent efficacy to cyclophosphamide and mycophenolate mofetil for inducing remission of lupus nephritis. Although rituximab has shown promise in refractory lupus nephritis, combining rituximab with mycophenolate mofetil as initial therapy offers no additional benefit. Considerable interethnic variation is evident in the efficacy and tolerability of the various immunosuppressive regimens, which necessitates individualized treatment and comparison of the efficacy of new regimens across different ethnic groups. For example, low-dose combinations of tacrolimus and mycophenolate mofetil seem to be more effective than pulse cyclophosphamide as induction therapy in Chinese patients. The same regimen has also been used successfully to treat refractory proliferative and membranous lupus nephritis in patients of various ethnic groups. Finally, novel serum and urinary biomarkers are being validated for diagnosis, prognostic stratification and early recognition of flares in lupus nephritis.
authors.affiliation: Department of Medicine, Tuen Mun Hospital, 23 Tsing Chung Koon Road, New Territories, Hong Kong SAR, China.
authors.forename: C C
authors.initials: CC
authors.lastname: Mok
mesh_terms: D000069594:Abatacept / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D001685:Biological Factors / Q000627:therapeutic use; D015415:Biomarkers / Q000032:analysis; D065095:Calcineurin Inhibitors / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D000074049:Cytokine TWEAK; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D008181:Lupus Nephritis / Q000175:diagnosis / Q000188:drug therapy* / Q000652:urine; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D057285:Precision Medicine; D015363:Quinolones / Q000627:therapeutic use; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D000069283:Rituximab / Q000627:therapeutic use; D048069:Tumor Necrosis Factors / Q000276:immunology
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D001685:Biological Factors; D015415:Biomarkers; D065095:Calcineurin Inhibitors; D000074049:Cytokine TWEAK; D007155:Immunologic Factors; D015363:Quinolones; D011993:Recombinant Fusion Proteins; C109743:TNFSF12 protein, human; D048069:Tumor Necrosis Factors; D000069283:Rituximab; C511911:belimumab; D000069594:Abatacept; D003520:Cyclophosphamide; C476223:laquinimod; C533411:ocrelizumab; D009173:Mycophenolic Acid; C524618:TACI receptor-IgG Fc fragment fusion protein