This review on the management of lupus nephritis is based on the results of randomized clinical trials, and discusses the principles of treatment and the current options for induction and maintenance therapy. The respective place of mycophenolate mofetil and intravenous cyclophosphamide are balanced, taking into account efficacy, safety and patients’ perspective. The authors anticipate that, in a few years, when long-term data on lupus nephritis patients induced with mycophenolate mofetil becomes available, it is probably that intravenous cyclophosphamide, which has been for so long the ‘standard of care’, will be prescribed only in specialized conditions such as documented necrotizing vasculitis.
Get full access to this article
View all access options for this article.
References
1.
1 Houssiau FA . Management of lupus nephritis: an update.J Am Soc Nephrol2004; 15: 2694 – 2704 .
2.
2 Houssiau FAVasconcelos CD’Cruz D . Early response to immunosuppressive therapy predicts good renal outcome in lupus nephritis: lessons from long-term follow-up of patients in the Euro-Lupus Nephritis Trial.Arthritis Rheum2004; 50: 3934 – 3940 .
3.
3 Cervera RKhamashta MAFont J . Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients.Medicine (Baltimore)2003; 82: 299 – 308 .
4.
4 Ginzler EMDooley MAAranow C . Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis.N Engl J Med2005; 353: 2219 – 2228 .
5.
5 Ginzler EM; Appel GB; Dooley MA; . Mycophenolate mofetil and intravenous cyclophosphamide in the Aspreva Lupus Management Study (ALMS): efficacy by racial group. American College of Rheumatology Meeting 2007; Boston, Late Breaking Abstract 13.
6.
6 Moroni GGallelli BOuaglini S . Withdrawal of therapy in patients with proliferative lupus nephritis: long-term follow-up.Nephrol Dial Transplant2006; 21: 1541 – 1548 .
7.
7 Blumenfeld ZShapiro DShteinberg MAvivi INahir M . Preservation of fertility and ovarian function and minimizing gonadotoxicity in young women with systemic lupus erythematosus treated by chemotherapy.Lupus2000; 9: 401 – 405 .
8.
8 Austin HAKlippel JHBalow JE . Therapy of lupus nephritis. Controlled trial of prednisone and cytotoxic drugs.N Engl J Med1986; 314: 614 – 619 .
9.
9 Boumpas DTAustin HAVaughn EM . Controlled trial of pusle methylprednisolone versus two regimens of pulse cyclophosphamide in severe lupus nephritis.Lancet1992; 340: 741 – 745 .
10.
10 Gourley MFAustin HAScott D . Methylprednisolone and cyclophosphamide, alone or in combination, in patients with lupus nephritis. A randomized, controlled trial.Ann Intern Med1996; 125: 549 – 557 .
11.
11 Flanc RSRoberts MAStrippoli GFChadban SJKerr PGAtkins RC . Treatment of diffuse proliferative lupus nephritis: a meta-analysis of randomized controlled trials.Am J Kidney Dis2004; 43: 197 – 208 .
12.
12 Dooley MAHogan SJennette CFalk R . for the Glomerular Disease Collaborative Network.Cyclophosphamide therapy for lupus nephritis: poor renal survival in black Americans.Kidney Int1997; 51: 1188 – 1195 .
13.
13 Houssiau FAD’Cruz DPHaga HJHughes GR . Short course of weekly low-dose intravenous pulse cyclophosphamide in the treatment of lupus nephritis: a preliminary study.Lupus1991; 1: 31 – 35 .
14.
14 Haga HJD’Cruz DAsherson RHughes GR . Short term effects of intravenous pulses of cyclophosphamide in the treatment of connective tissue disease crisis.Ann Rheum Dis1992; 51: 885 – 888 .
15.
15 Houssiau FAVasconcelos CD’Cruz D . Immunosuppressive therapy in lupus nephritis: the Euro-Lupus Nephritis Trial, a randomized trial of low-dose versus high-dose intravenous cyclophosphamide.Arthritis Rheum2002; 46: 2121 – 2131 .
17 Urowitz MBIbañez DAli YGladman DD . Outcomes in patients with active lupus nephritis requiring immunosuppressives who never received cyclophosphamide.J Rheumatol2007; 34: 1491 – 1496 .
18.
18 Grootscholten CLigtenberg GHagen EC . Azathioprine/methylprednisolone versus cyclophosphamide in proliferative lupus nephritis. A randomized controlled trial.Kidney Int2006; 70: 732 – 742 .
19.
19 Grootscholten CBajema IMFlorquin S . Treatment with cyclophosphamide delays the progression of chronic lesions more effectively than does treatment with azathioprine plus methylprednisolone in patients with proliferative lupus nephritis.Arthritis Rheum2007; 56: 924 – 937 .
20.
20 Chan TMLi FKTang CS . Efficacy of mycophenolate mofetil in patients with diffuse proliferative lupus nephritis. Hong Kong-Guangzhou Nephrology Study Group.N Engl J Med2000; 343: 1156 – 1162 .
21.
21 Chan TMTse KCTang CSMok MYLi FK . ; Hong Kong Nephrology Study Group.Long-term study of mycophenolate mofetil as continuous induction and maintenance treatment for diffuse proliferative lupus nephritis.J Am Soc Nephrol2005; 16: 1076 – 1084 .
22.
22 Contreras GPardo VLeclercq B . Sequential therapies for proliferative lupus nephritis.N Engl J Med2004; 350: 971 – 980 .
23.
23 El Hachmi MJadoul MLefèbvre CDepresseux GHoussiau FA . Relapses of lupus nephritis: incidence, risk factors, serology and impact on outcome.Lupus2003; 12: 692 – 696 .
24.
24 Le Meur YBüchler MThierry A . Individualized mycophenolate mofetil dosing based on drug exposure significantly improves patient outcomes after renal transplantation.Am J Transplant2007; 7: 2496 – 2503 .
25.
25 Furie R . Abetimus sodium (riquent) for the prevention of nephritic flares in patients with systemic lupus erythematosus.Rheum Dis Clin North Am2006; 32: 149 – 156 .
26.
26 Wallace DJLisse JStohl W . Belimumab (BmAb) reduces SLE disease activity and demonstrates durable bioactivity at 76 weeks. American College of Rheumatology Meeting 2006; Washington DC, Abstract 2012.
27.
27 Sfikakis PPBoletis JNTsokos GC . Rituximab anti-B-cell therapy in systemic lupus erythematosus: pointing to the future.Curr Opin Rheumatol2005; 17: 550 – 557 .
