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Optimum therapeutic approaches for lupus nephritis: what therapy and for whom?

Abstract

The optimum therapy for patients with lupus nephritis is a hotly debated topic. Prospective randomized studies in patients with proliferative lupus nephritis have established the superiority of cyclophosphamide to azathioprine, both of which are used in combination with corticosteroids. Although high-dose, intermittent administration of cyclophosphamide (pulse therapy) has significantly reduced the toxicity associated with this drug, premature ovarian failure and infections remain considerable problems. Short-term to intermediate-term, randomized controlled trials have shown that mycophenolate mofetil is a good option for the induction and maintenance of remission in lupus nephritis patients. Additional longer-term trials involving more patients and stricter outcomes based on renal function are needed, however, before claims that mycophenolate mofetil is superior to cyclophosphamide can be substantiated. Until such data are available, physicians caring for patients with lupus nephritis can use mycophenolate mofetil as induction or maintenance therapy for selected patients under close observation. Small noncontrolled trials with short-term follow-up suggest that up to 50% of patients who are refractory to cyclophosphamide might have a clinically significant response to rituximab, a monoclonal antibody directed against B cells.

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  • Authors+Show Affiliations

    ,

    Departments of Internal Medicine and of Rheumatology, Clinical Immunology and Allergy, at the Medical School, University of Crete, Greece. boumpasd@med.uoc.gr

    ,

    Source

    MeSH

    Drug Therapy, Combination
    Glucocorticoids
    Humans
    Immunosuppressive Agents
    Lupus Nephritis
    Randomized Controlled Trials as Topic
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    16932624

    Citation

    Boumpas, Dimitrios T., et al. "Optimum Therapeutic Approaches for Lupus Nephritis: what Therapy and for Whom?" Nature Clinical Practice. Rheumatology, vol. 1, no. 1, 2005, pp. 22-30.
    Boumpas DT, Sidiropoulos P, Bertsias G. Optimum therapeutic approaches for lupus nephritis: what therapy and for whom? Nat Clin Pract Rheumatol. 2005;1(1):22-30.
    Boumpas, D. T., Sidiropoulos, P., & Bertsias, G. (2005). Optimum therapeutic approaches for lupus nephritis: what therapy and for whom? Nature Clinical Practice. Rheumatology, 1(1), pp. 22-30.
    Boumpas DT, Sidiropoulos P, Bertsias G. Optimum Therapeutic Approaches for Lupus Nephritis: what Therapy and for Whom. Nat Clin Pract Rheumatol. 2005;1(1):22-30. PubMed PMID: 16932624.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Optimum therapeutic approaches for lupus nephritis: what therapy and for whom? AU - Boumpas,Dimitrios T, AU - Sidiropoulos,Prodromos, AU - Bertsias,George, PY - 2005/05/24/received PY - 2005/07/01/accepted PY - 2006/8/26/pubmed PY - 2006/9/27/medline PY - 2006/8/26/entrez SP - 22 EP - 30 JF - Nature clinical practice. Rheumatology JO - Nat Clin Pract Rheumatol VL - 1 IS - 1 N2 - The optimum therapy for patients with lupus nephritis is a hotly debated topic. Prospective randomized studies in patients with proliferative lupus nephritis have established the superiority of cyclophosphamide to azathioprine, both of which are used in combination with corticosteroids. Although high-dose, intermittent administration of cyclophosphamide (pulse therapy) has significantly reduced the toxicity associated with this drug, premature ovarian failure and infections remain considerable problems. Short-term to intermediate-term, randomized controlled trials have shown that mycophenolate mofetil is a good option for the induction and maintenance of remission in lupus nephritis patients. Additional longer-term trials involving more patients and stricter outcomes based on renal function are needed, however, before claims that mycophenolate mofetil is superior to cyclophosphamide can be substantiated. Until such data are available, physicians caring for patients with lupus nephritis can use mycophenolate mofetil as induction or maintenance therapy for selected patients under close observation. Small noncontrolled trials with short-term follow-up suggest that up to 50% of patients who are refractory to cyclophosphamide might have a clinically significant response to rituximab, a monoclonal antibody directed against B cells. SN - 1745-8382 UR - https://www.unboundmedicine.com/medline/citation/16932624/Optimum_therapeutic_approaches_for_lupus_nephritis:_what_therapy_and_for_whom L2 - http://dx.doi.org/10.1038/ncprheum0016 DB - PRIME DP - Unbound Medicine ER -