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Treatment Options for Proliferative Lupus Nephritis

An Update of Clinical Trial Evidence

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Abstract

Systemic lupus erythematosus involves the kidney in up to 60% of patients, and if untreated, may result in complete loss of kidney function. In this article, we review meta-analyses and clinical trial data on the therapeutic options for proliferative lupus nephritis, and complete a meta-analysis of the use of mycophenolate mofetil (MMF) compared with cyclophosphamide-based regimens. Clinical trials have found that cyclophosphamide-based regimens result in a decreased risk of end-stage renal disease, but are associated with significant toxicity in lupus nephritis. Even though the survival advantage of the US National Institutes of Health and Euro-Lupus regimens based on intravenous and oral cyclophosphamide has not been established, these approaches are broadly adopted in proliferative lupus nephritis. Recent studies have confirmed the therapeutic equivalence and potential comparative superiority of MMF and cyclophosphamide in induction of remission in patients with lupus nephritis. Use of MMF resulted in a lower incidence of infection and loss of gonadal function compared with cyclophosphamide regimens. Cyclophosphamide plus corticosteroids could represent the induction agents of choice in patients with severe lupus nephritis, whereas MMF could be used as an induction agent in patients with mild disease, patients who wish to preserve fertility and those at high risk of infections. However, given the complexity of disease activity in patients with lupus nephritis, the initial treatment options need to be individualized and altered based on the subsequent treatment response. Ongoing clinical trials will provide further evidence.

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  1. See http://www.update-software.com/publications/Renal/default.html.

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Acknowledgements

No sources of funding were used to assist in the preparation of this manuscript. The authors have no conflicts of interest that are directly relevant to the content of this review.

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Authors and Affiliations

  1. Department of Nephrology and Hypertension, Cleveland Clinic, 9500 Euclid Avenue-A51, Cleveland, Ohio, 44195, USA

    Sankar D. Navaneethan

  2. Department of Medicine, St Catherine Hospital, East Chicago, Illinois, USA

    Gautham Viswanathan

  3. Mario Negri Sud Consortium, S. Maria Imbaro, Italy

    Giovanni F. M. Strippoli

  4. Diaverum Medical-Scientific Office, Lund, Sweden

    Giovanni F. M. Strippoli

Authors
  1. Sankar D. Navaneethan
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  2. Gautham Viswanathan
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  3. Giovanni F. M. Strippoli
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Correspondence to Sankar D. Navaneethan.

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Navaneethan, S.D., Viswanathan, G. & Strippoli, G.F.M. Treatment Options for Proliferative Lupus Nephritis. Drugs 68, 2095–2104 (2008). https://doi.org/10.2165/00003495-200868150-00002

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