Recent Progress in the Treatment of Proliferative Lupus Nephritis

• Published in: The American journal of medicine Vol. 125; no. 7; pp. 642 - 648
• Main Author: Chan, Tak Mao, MD, FRCP
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2012; Elsevier; Elsevier Sequoia S.A
• Subjects: Azathioprine; Biological and medical sciences; Cyclophosphamide; Cyclophosphamide - therapeutic use; General aspects; Humans; Immunosuppressive Agents - therapeutic use; Internal Medicine; Kidneys; Lupus; Lupus nephritis; Lupus Nephritis - drug therapy; Medical sciences; Medical treatment; Mycophenolate mofetil; Mycophenolic Acid - analogs & derivatives; Mycophenolic Acid - therapeutic use; Nephrology. Urinary tract diseases; Quality of life; Risk factors; Urinary system involvement in other diseases. Miscellaneous; Cyclophosphamide; Lupus nephritis; Mycophenolate mofetil; Azathioprine; Kidney disease; Cell proliferation; Medicine; Immunopathology; Connective tissue disease; Skin disease; Urinary system disease; Treatment; Systemic disease; Autoimmune disease
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/j.amjmed.2012.01.024

Abstract The recent decades have witnessed significant progress in the treatment of lupus nephritis. Existing immunosuppressive regimens have been refined to enhance efficacy and reduce adverse effects, resulting in improvements in renal and patient survival and patients' quality of life. This review focuses on the new treatments that have emerged over the past 2 decades. The data and methodology of important clinical trials are discussed to highlight the important findings and their limitations. The role of mycophenolate mofetil as induction or maintenance immunosuppressive treatment is discussed in detail. Racial variations in prognosis and treatment response are evident. With increasing treatment options and better appreciation of patient characteristics that impact on response and tolerance, the management of lupus nephritis has become more individualized. The choice and the dosing regimen of immunosuppressive agents should take into account factors such as race, type of lupus nephritis, disease severity, renal reserve, and prior disease course, to aim for an optimal balance of benefit and risk.