Treatment of severe lupus nephritis: the new horizon

Chan, Tak Mao

doi:10.1038/nrneph.2014.215

Cited by 85 publications

(71 citation statements)

References 163 publications

(198 reference statements)

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“…CYC is often the agent of choice for many clinicians owing to easy accessibility and cost; however, the use of MMF is increasing. Various studies have assessed the efficacy and safety of CYC with MMF or placebo for induction therapy in patients with LN (reviewed in depth by Chan [9] ). The recommended duration of induction therapy is 6 months; during this time, the dose of oral corticosteroid should be weaned.…”

Section: Fig 2 Treatment Approach For Patients With Lupus Nephritismentioning

confidence: 99%

Lupus nephritis: A simplified approach to diagnosis and treatment in South Africa

2015

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Section: Fig 2 Treatment Approach For Patients With Lupus Nephritismentioning

confidence: 99%

Lupus nephritis: A simplified approach to diagnosis and treatment in South Africa

2015

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“…Immunosuppressive treatment of active severe LN begins with an induction phase in which potent immunosuppressive medications are administered to abrogate renal inflammation. This phase lasts for approximately 4-6 months and is followed by a prolonged maintenance phase in which low-dose immunosuppression is conducted to prevent relapses [29]. The distinction between the induction phase and the maintenance phase is clear in sequential immunosuppressive regimens such as cyclophosphamide (CYC) followed by either mycophenolic acid (MPA) or azathioprine (AZA), but it becomes a gradual evolution with continuous regimens, for example when MPA is used for both induction and maintenance purposes.…”

Section: Current Immunosuppressive Treatments For Ln: An Asian Perspementioning

confidence: 99%

Lupus Nephritis in Asia: Clinical Features and Management

Yap

Chan²

2015

Kidney Dis

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Background: Lupus nephritis (LN) is a common and severe organ involvement manifesting itself in systemic lupus erythematosus (SLE). There is a considerable difference in prevalence, severity, treatment response and outcomes between Asian LN patients and LN patients from other racial backgrounds. Summary: Asian SLE patients have a higher prevalence of LN than Caucasian SLE patients and often present with a more severe disease. Increasing data from genetic studies, accompanied by progress in high-throughput genotyping, have advanced our knowledge about genetic predispositions that might partly contribute to the clinical variations observed. Corticosteroids combined with either cyclophosphamide (CYC) or mycophenolic acid (MPA) is the current standard-of-care induction regimen for severe LN irrespective of race or ethnicity. However, the preference for MPA or CYC, and possibly the optimum dose for MPA, is influenced by the patient's origin. Also, there is an insufficient evidence base for reduced-dose intravenous CYC in Asian patients. Health economics and access to prompt diagnosis and treatment are still challenging issues in some Asian regions. The former represents a significant obstacle limiting the access of patients to MPA despite the proven efficacy of the drug as an induction agent and its superiority over azathioprine (AZA) in preventing disease flares when used for long-term maintenance immunosuppression. Calcineurin inhibitors such as tacrolimus deserve further investigation in view of their additional effect on podocytes by reducing proteinuria and the promising data from Asian patients. Despite considerable advances in the clinical management of LN over the past few decades with resultant improvements in patients' outcomes, there are still knowledge gaps and unmet clinical needs. Asia has made substantial contributions to the evidence base that guides clinical management and continues to offer invaluable opportunities for research pursuits. Key Messages: Treatment responses and clinical outcomes in Asian patients with LN compare favorably with patients from other parts of the world. The prevention and treatment of infective complications remain significant challenges in managing LN in Asia. Facts from East and West: (1) The prevalence of SLE is lower among Caucasians than other ethnicities. A higher prevalence is observed among Asians and African Americans, while the highest prevalence is found in Caribbean people. The prevalence of LN in Asian SLE patients is much higher than in Caucasians as well. However, the 10-year renal outcome and renal survival rate appear to be better in Asians. (2) Polymorphisms of genes involved in the immune response, such as Fcγ receptor, integrin alpha M, TNF superfamily 4, myotubularin-related protein 3 and many others, might be partly responsible for the differences in prevalence between the different ethnic groups. European ancestry was shown to be associated with a decrease in the risk of LN even after adjustment for genes most associated with renal disease. (3) Access...

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“…Characteristic of this disease is the production of autoantibodies to nuclear antigens such as ribonucleoproteins, dsDNA, and histones. Autoantibody production by self-reactive B cells is further amplified by the activation of the innate immune system and secretion of type I IFN encoded by the IFNA and IFNB gene families (1)(2)(3). Renal involvement in SLE occurs in about half of the patients and is one of the leading causes of morbidity and a significant contributor to mortality (1).…”

Section: Introductionmentioning

confidence: 99%