Tacrolimus is an alternative therapeutic option for the treatment of refractory lupus nephritis

• Published in: Lupus Vol. 19; no. 8; pp. 974 - 980
• Main Authors: Lee, T., Oh, K-H., Joo, KW, Kim, YS, Ahn, C., Han, JS, Kim, S., Chin, HJ
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.07.2010; Sage Publications Ltd
• Subjects: Adult; Cyclophosphamide - therapeutic use; Disease Progression; Female; Humans; Immunosuppressive Agents - therapeutic use; Lupus Nephritis - drug therapy; Lupus Nephritis - physiopathology; Male; Middle Aged; Prospective Studies; Tacrolimus - therapeutic use; Treatment Failure; Treatment Outcome; lupus nephritis; systemic lupus erythematosus; proteinuria; tacrolimus
• ISSN: 0961-2033; 1477-0962
• DOI: 10.1177/0961203310366573

We conducted an open-labeled, prospective study to determine the efficacy and safety of tacrolimus as an alternative therapeutic option for those patients with refractory lupus nephritis. The study population comprised one male and eight female patients with diffuse proliferative lupus nephritis. All patients had failed to respond to sufficient intravenous cyclophosphamide therapy with proteinuria of ≥1 g/day and active urinary sediments. Tacrolimus (0.1 mg/kg/day) was administered for 1 year with adjusting drug level (4—10 µg/l). The mean serum creatinine level and spot urine protein creatinine ratio (UPCR) at baseline were 1.39 mg/dl and 2.27, respectively. After the treatment, proteinuria reduced significantly from median UPCR value of 2.19 (range, 1.19—3.34) to 0.44 (range, 0.12—2.13) (p < 0.05). Seven (78%) of the nine patients showed a complete clinical response, which was defined as stabilization in the disease-activity markers and serum creatinine level with reduction of ≥50% in UPCR; two patients showed complete remission with UPCR <0.2. One patient showed treatment failure because of the disease progression. No serious adverse effects were observed during the study. This study demonstrates that tacrolimus can show a significant therapeutic response in cases that are refractory to the standard regimen for diffuse proliferative lupus nephritis.