[Effective treatment of a refractory case of systemic lupus erythematosus with low-dose tacrolimus]

It has been reported that aggressive immunosuppressive treatment is effective for controlling the disease activity of refractory systemic lupus erythematosus (SLE). However, little information on a regimen including tacrolimus (TL) for the treatment of refractory SLE has been available. We report a successful low dose TL treatment of a 25-year-old male patient with refractory SLE. He developed SLE with proliferative lupus nephritis(WHO class IVb) at the age of 11 years. During the past 4 years, despite aggressive immunosuppressive treatment consisting of methylprednisolone pulse therapy, mizoribine pulse therapy, cyclosporine A and intravenous cyclophosphamide pulse therapy, frequent flares associated with presumptive hypercytokinemia i.e., increased levels in the serum C-reactive protein, ferritin and soluble IL-2 receptor, occurred. Hence, administration of low-dose TL at 3 mg per day, was initiated. The blood levels of TL at approximately 12 hours post-dosing were maintained at between 3 and 5 ng/mL. Within 3 weeks following TL administration, the serum levels of C3, C4 and CH50 began to increase rapidly, and the prednisolone dose could be successfully tapered. No adverse effects of TL were observed. We suggest that TL may be the treatment of choice for selected patients with refractory SLE.