title: Expanding the therapeutic options for renal involvement in lupus: eculizumab, available evidence.
abstract: In this study, we aimed to systematically review available literature on the efficacy of eculizumab for the treatment of renal involvement in patients with systemic lupus erythematosus (SLE). We conducted a literature search developed a priori, to identify articles reporting clinical experience with the use of eculizumab in SLE patients, focusing on renal involvement. The search strategy was applied to Ovid MEDLINE, EMBASE, In-Process and Other Non-Indexed Citation, Cochrane Central Register of Controlled Trials and Scopus from 2006 to present. Abstracts from EULAR and ACR congresses were also screened. We included six publications describing the renal outcome in SLE patients receiving eculizumab. Five out of six cases described the occurrence of thrombotic microangiopathy (TMA) in renal biopsies of patients with known SLE; three cases with biopsy-proven lupus nephritis (LN) and two patients with SLE-related antiphospholipid syndrome without histologic evidence of LN. One study reported the outcome of a patient with severe refractory LN successfully treated with eculizumab. All patients, regardless of the presence of concomitant LN, presented with severe hypocomplementemia and renal function impairment. All patients showed a sustained improvement of renal function and normalization of complement parameters after treatment with eculizumab[median follow-up 9 months (1-17)]. Despite the limitations of the currently available evidence, existing data are promising and provide preliminary support for the use of eculizumab in selected cases of SLE with renal involvement, especially in the presence of TMA, or in patients with refractory LN.
authors.affiliation: Department of Clinical and Biological Sciences, Center of Research of Immunopathology and Rare Diseases-Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Hospital, University of Turin, piazza del donatore di Sangue 3, 10054, Turin, Italy. savino.sciascia@unito.it.|Department of Clinical and Biological Sciences, SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, University of Turin, Turin, Italy. savino.sciascia@unito.it.
authors.forename: Savino
authors.initials: S
authors.lastname: Sciascia
authors.affiliation: Department of Clinical and Biological Sciences, Center of Research of Immunopathology and Rare Diseases-Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Hospital, University of Turin, piazza del donatore di Sangue 3, 10054, Turin, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Radin
authors.affiliation: Division of Rheumatology, Russell/Engleman Research Center, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Jinoos
authors.initials: J
authors.lastname: Yazdany
authors.affiliation: First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Tektonidou
authors.affiliation: Department of Clinical and Biological Sciences, Center of Research of Immunopathology and Rare Diseases-Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Hospital, University of Turin, piazza del donatore di Sangue 3, 10054, Turin, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Cecchi
authors.affiliation: Department of Clinical and Biological Sciences, Center of Research of Immunopathology and Rare Diseases-Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Hospital, University of Turin, piazza del donatore di Sangue 3, 10054, Turin, Italy.|Department of Clinical and Biological Sciences, SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, University of Turin, Turin, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Roccatello
authors.affiliation: Division of Rheumatology, Russell/Engleman Research Center, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Dall'Era
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D016736:Antiphospholipid Syndrome / Q000150:complications; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology; D008181:Lupus Nephritis / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D008297:Male; D012076:Renal Agents / Q000008:administration & dosage*; D057049:Thrombotic Microangiopathies / Q000150:complications / Q000188:drug therapy*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D012076:Renal Agents; C481642:eculizumab
keywords: Antiphospholipid antibodies; Complement; Eculizumab; Lupus nephritis; Systemic lupus erythematosus