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Optimum therapeutic approaches for lupus nephritis: what therapy and for whom?
Nat Clin Pract Rheumatol 2005; 1(1):22-30NC

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.

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.grNo affiliation info availableNo affiliation info available

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 -