Treatment of Lupus Nephritis with Cyclosporine – An Outcome Analysis

Abstract

Background: The optimal therapy for lupus nephritis (LN), including the role of cyclosporine (CsA), still lacks scientifically valid clinical experience. We evaluated the efficacy of CsA in the induction and maintenance treatment of patients with biopsy-proven LN. Patients and Methods: A total of 31 patients (25 women, 6 men, mean age 29.5 years) were enrolled in the study. The majority had proliferative LN. The mean follow-up was 85.6 ± 24.7 months. Results: CsA was used as first-line treatment in 38.7% of patients and as second-line treatment in 61.3% of patients. Complete remission was achieved in 93.5% of patients. The relapse rate was 45.2%. The mean disease-free interval was 33 months. At the end of follow-up, a total of 67.9% of the patients were in remission. The treatment led to significant improvement in proteinuria (p = 0.001) and stabilization of renal function. Conclusion: CsA might be an appropriate and a less toxic alternative drug for LN both as a first-choice and rescue therapy.

Lupus Nephritis

“…A long-term retrospective study has demonstrated high complete remission rates with long relapse-free intervals when CSA was used as a first-or second-line agent for LN (30). CSA was found to be equally effective as maintenance therapy for LN compared with azathioprine (31).…”

“…The most significant side effects of CSA are hypertension, hyperlipidemia, gingival hyperplasia, and hirsutism (25,27,30). Dose adjustments may be required due to the risk of nephrotoxicity.…”

“…Dose adjustments may be required due to the risk of nephrotoxicity. Disease relapses may occur after the withdrawal of the drug (30).…”

Treatment of Pediatric-Onset Lupus Nephritis: A New Option of Less Cytotoxic Immunosuppressive Therapy

“…Some studies have recently suggested that cyclosporine A (CsA), a calcineurin inhibitor similar to Tac, might replace cytotoxic agents and reduce the dosage of concomitantly administered PDN for maintenance therapy in selected patients with lupus nephritis (Rihova et al, 2007;Moroni et al, 2008). It has been reported CsA treatment has beneficial effects in some pediatric patient with SLE resistant to conventional immunosuppressive therapy, including iv-CPA (Sakano et al, 2004;Suzuki et al, 2006).…”

Experiencia en la utilización de inhibidores de calcineurin a bajas dosis en el tratamiento de nefritis lúpica refractaria

“…Aparte del perfil de nefrotoxicidad de los inhibidores de calcineurin a dosis altas y por periodos prolongados, un problema que se ha detectado con su administración es la alta tasa de recaídas posterior a su retiro, informándose en el estudio de Rihova valores cercanos al 46% 21 , creándose un grupo de pacientes dependientes de ciclosporina. Es importante también anotar que ante el riesgo que portan de empeorar la función renal se recomienda evitar la ciclosporina cuando la tasa de filtración glomerular es inferior a 60 ml/minuto y la biopsia renal demuestra severa fibrosis tubulointersticial.…”