The safety of pharmacological treatment options for lupus nephritis

• Published in: Expert opinion on drug safety Vol. 15; no. 8; p. 1041
• Main Authors: Velo-García, Alba, Ntatsaki, Eleana, Isenberg, David
• Format: Journal Article
• Language: English
• Published: England 02.08.2016
• Subjects: Biological Products - adverse effects; Biological Products - therapeutic use; Cyclophosphamide - administration & dosage; Cyclophosphamide - adverse effects; Cyclophosphamide - therapeutic use; Dose-Response Relationship, Drug; Glucocorticoids - administration & dosage; Glucocorticoids - adverse effects; Glucocorticoids - therapeutic use; Humans; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Lupus Nephritis - drug therapy; Lupus Nephritis - physiopathology; Mycophenolic Acid - administration & dosage; Mycophenolic Acid - adverse effects; Mycophenolic Acid - therapeutic use; Randomized Controlled Trials as Topic - methods; Remission Induction - methods; Time Factors; treatment; cyclophosphamide; lupus nephritis; Safety; biologics
• ISSN: 1744-764X
• DOI: 10.1080/14740338.2016.1182496

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. 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. 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.