An overview of current and future treatment methods for lupus nephritis

Abstract

Introduction: Renal involvement affects over half of the patients with systemic lupus erythematosus. Lupus nephritis (LN) is an important cause of morbidity, mortality and renal failure. Treatment of LN has evolved over the past few decades with the advent of new therapeutic options, and the clinical outcome of patients has improved substantially.

Areas covered: This review covers data from the clinical studies to date, focusing on the short- and long-term efficacy and safety, on different immunosuppressives, including corticosteroids, cyclophosphamide (CYC), azathioprine (AZA), mycophenolate mofetil (MMF), calcineurin inhibitors (CNI), biologic agents (e.g., anti-CD20, anti-BAFF, CTLA4-Ig) and other novel immunomodulatory drugs.

Expert opinion: Initial treatment for active proliferative and/or membranous LN should be corticosteroids combined with either CYC or MMF. MMF has the advantages of improved tolerability and ease of administration, and also higher efficacy in patients of African or Hispanic descent. Preliminary data suggest that CYC treatment may lead to a more sustained response, especially in patients with most severe disease. Low-dose corticosteroids with either MMF or AZA, or CNI, can be used as long-term maintenance immunosuppression, and the choice depends on prior induction treatment, history of relapse, and considerations of pregnancy and finance.