title: The safety of pharmacological treatment options for lupus nephritis.
abstract: BACKGROUND
  The management of lupus nephritis (LN) has changed significantly over the last 10 years due to emerging evidence from large randomised clinical trials that produced good quality data and guided the formulation of two key concepts: the induction of remission and the maintenance phase of immunosuppressive therapy.
  
  
  METHODS
  Optimizing cyclophosphamide and glucocorticoid regimens and the introduction of mycophenolate mofetil for proliferative and membranous LN has been pivotal. Nevertheless, concerns remain about treatment toxicity especially long term glucocorticoid use and exposure to cumulative cyclophosphamide doses. Here we discuss the conventional and newer pharmacological options for managing LN focusing on drug safety and toxicity issues.
  
  
  CONCLUSIONS
  The need for effective and less toxic treatments led to the development of the role of targeted biologic therapies in LN. However, evidence from the initial randomized controlled trials has been disappointing, although this reflects inadequate trial design rather than true lack of efficacy.
authors.affiliation: a Internal Medicine Department , University Hospital Complex of Pontevedra , Pontevedra , Spain.|b Centre for Rheumatology, Division of Medicine , University College London , UK.
authors.forename: Alba
authors.initials: A
authors.lastname: Velo-García
authors.affiliation: b Centre for Rheumatology, Division of Medicine , University College London , UK.
authors.forename: Eleana
authors.initials: E
authors.lastname: Ntatsaki
authors.affiliation: b Centre for Rheumatology, Division of Medicine , University College London , UK.
authors.forename: David
authors.initials: D
authors.lastname: Isenberg
mesh_terms: D001688:Biological Products / Q000009:adverse effects / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008181:Lupus Nephritis / Q000188:drug therapy* / Q000503:physiopathology; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012074:Remission Induction / Q000379:methods; D013997:Time Factors
chemical_list: D001688:Biological Products; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D009173:Mycophenolic Acid
keywords: Safety; biologics; cyclophosphamide; lupus nephritis; treatment