Treatment options for severe lupus nephritis

Area of Science:

• Nephrology
• Rheumatology
• Immunology

Background:

• Lupus nephritis, a kidney complication of systemic lupus erythematosus, significantly impacts patient morbidity and mortality.
• Cyclophosphamide, established by NIH trials, improved prognosis but caused adverse events like infections and gonadal failure.
• The relapsing nature of lupus nephritis necessitates improved therapeutic strategies.

Purpose of the Study:

• To review established and novel treatment options for severe lupus nephritis (WHO classes III, IV, V with III or V with IV).
• To highlight the evolution of lupus nephritis treatment towards better remission rates and reduced toxicity.
• To discuss emerging therapeutic targets based on B and T cell activation pathways.

Main Methods:

• Review of landmark trials and recent therapeutic developments in lupus nephritis management.
• Discussion of established therapies including cyclophosphamide.
• Exploration of newer protocols such as mycophenolate mofetil induction and sequential therapies.
• Consideration of novel treatment targets informed by disease pathogenesis research.

Main Results:

• Cyclophosphamide therapy improved 10-year survival rates for lupus nephritis to over 75%.
• Despite improved survival, significant adverse events and disease relapse remain challenges.
• Alternative protocols like mycophenolate mofetil offer potential for sustained remission with fewer side effects.

Conclusions:

• Treatment for lupus nephritis has advanced, improving patient survival significantly.
• Current research focuses on balancing efficacy with reduced toxicity and managing disease relapse.
• Understanding B and T cell roles in pathogenesis opens avenues for targeted therapies in lupus nephritis.