Successful Treatment of Class V+IV Lupus Nephritis with Multitarget Therapy

• Published in: Journal of the American Society of Nephrology Vol. 19; no. 10; pp. 2001 - 2010
• Main Authors: HAO BAO, LIU, Zhi-Hong, XIE, Hong-Lang, HU, Wei-Xin, ZHANG, Hai-Tao, LI, Lei-Shi
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.10.2008; American Society of Nephrology
• Subjects: Adult; Biological and medical sciences; Clinical Research; Drug Therapy, Combination; Enzyme Inhibitors - administration & dosage; Female; Glucocorticoids - administration & dosage; Humans; Immunosuppressive Agents - administration & dosage; Kidneys; Lupus Nephritis - drug therapy; Lupus Nephritis - pathology; Male; Medical sciences; Mycophenolic Acid - administration & dosage; Nephrology. Urinary tract diseases; Prednisone - administration & dosage; Prospective Studies; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Tacrolimus - administration & dosage; Treatment Outcome; Urinary system involvement in other diseases. Miscellaneous; Steroid; Skin disease; Nephrology; Calcineurin inhibitor; Intravenous administration; Autoimmune disease; Lupus nephritis; Urology; Systemic lupus erythematosus; Systemic disease; Complication; Remission; Advanced stage; Kidney disease; Immunopathology; Connective tissue disease; Drug combination; Urinary system disease; Enzyme; IMP dehydrogenase; Enzyme inhibitor; Lactone; Macrolide; Induction treatment; Alkylating agent; Oxazaphosphinane derivatives; Chemotherapy; Cyclophosphamide; Treatment; Tacrolimus; Nitrogen mustard; Total; Oxidoreductases; Immunosuppressive agent; Mycophenolate mofetil
• ISSN: 1046-6673; 1533-3450
• DOI: 10.1681/ASN.2007121272

Treatment of class V+IV lupus nephritis remains unsatisfactory despite the progress made in the treatment of diffuse proliferative lupus nephritis. In this prospective study, 40 patients with class V+IV lupus nephritis were randomly assigned to induction therapy with mycophenolate mofetil, tacrolimus, and steroids (multitarget therapy) or intravenous cyclophosphamide (IVCY). Patients were treated for 6 mo unless complete remission was not achieved, in which case treatment was extended to 9 mo. An intention-to-treat analysis revealed a higher rate of complete remission with multitarget therapy at both 6 and 9 mo (50 and 65%, respectively) than with IVCY (5 and 15%, respectively). At 6 mo, eight (40%) patients in each group experienced partial remission, and at 9 mo, six (30%) patients receiving multitarget therapy and eight (40%) patients receiving IVCY experienced partial remission. There were no deaths during this study. Most adverse events were less frequent in the multitarget therapy group. Calcineurin inhibitor nephrotoxicity was not observed, but three patients developed new-onset hypertension with multitarget therapy. In conclusion, multitarget therapy is superior to IVCY for inducing complete remission of class V+IV lupus nephritis and is well tolerated.