Vol.22 No.6

Review Article

Recent progress in the treatment of lupus nephritis

Authors

Antonis Fanouriakis1 , Eleni Krasoudaki2 , Michail Tzanakakis3 , Dimitrios T. Boumpas1,4

  • Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, University of Crete Medical School, 71003, Heraklion, Greece
  • Department of Nephrology, Venizeleion Hospital of Heraklion, Heraklion, Greece
  • Department of Nephrology, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
  • Institute of Molecular Biology and Biotechnology (FORTH), Heraklion, Greece
Received:

31 January 2012

Accepted:

18 April 2012

Published online:

15 May 2012

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Abstract

The treatment of lupus nephritis has seen significant advances during the past decade mainly due to the publication of well-designed randomized clinical trials (RCTs). The choice of treatment is guided by the histopathologic classification but is also influenced by demographic, clinical, and laboratory characteristics that allow for the identification of patients at risk for more aggressive disease. For the induction arm, low-dose cyclophosphamide regimens and mycophenolate mofetil have been validated as alternatives to the established National Institutes of Health regimen of high-dose cyclophosphamide; for the maintenance phase, azathioprine and mycophenolate compete for treatment of first choice. Rituximab is efficacious in real-life clinical practice but ineffective in clinical trials. The role of recently approved belimumab in lupus nephritis eagerly awaits further documentation. Aggressive management of comorbid conditions, such as hypertension and dyslipidemia, is of utmost importance. Here, we review the latest advances in lupus nephritis therapy with a focus on recent RCTs as well as new biologic agents under development. Furthermore, we propose a therapeutic algorithm in an effort to facilitate clinical decision-making in this gradually changing landscape. Upcoming European and American recommendations should provide further clarification.

Key words

Biologics - Controlled trials - Lupus nephritis