Unmet medical needs in lupus nephritis: solutions through evidence-based, personalized medicine

Abstract

Lupus nephritis (LN) remains a kidney disease with significant unmet medical needs despite extensive clinical and translational research over the past decade. These include the need to (i) predict the individual risk for LN in a patient with systemic lupus erythematosus, (ii) identify the best therapeutic option for an individual patient, (iii) distinguish chronic kidney damage from active immunologic kidney injury, (iv) develop efficient treatments with acceptable or no side effects and improve the design of randomized clinical trials so that effective drugs demonstrate efficacy. This review discusses the underlying reasons for these unmet medical needs and options of how to overcome them in the future.

Refractory lupus nephritis: a survey

“…While there are already recommendations for initial LN drug choice based on ethnicity, 22 personalization of therapy will continue to change the traditional style of guidelines (‘one drug fits all’) towards an informed and individual therapy for each patient, based on validated clinical, pathological as well as pharmacogenomic patient characteristics. 5,21…”

“…APOL1 risk variants, promoting CKD progression independent of autoimmune disease activity, pharmacogenetics resistance to certain immunosuppressive drugs or concomitant other kidney diseases or renal drug toxicities. 5 The Lupus Nephritis Trials Network (LNTN) is a global network of LN specialists that seeks to develop a consensus definition for RLN to be implemented in future revisions of the current LN guidelines (http://lupusnephritis.org/). As a first step we performed a survey among the LNTN members and other decision takers in patients with LN to determine professional trends in defining and managing RLN in clinical practice.…”

“…APOL1 risk variants, promoting CKD progression independent of autoimmune disease activity, pharmacogenetics resistance to certain immunosuppressive drugs or concomitant other kidney diseases or renal drug toxicities. 5…”

La néphropathie lupique : les nouvelles perspectives de traitement

“…En effet, le taux de ré mission complè te se situe aux alentours de 50 % [33,34], engendrant un risque important d'é volution vers la MRC, voire l'insuffisance ré nale terminale. Les traitements actuels de la NL sont par ailleurs associé s à des effets secondaires sé rieux, tant à court terme qu'à long terme [35], notamment le risque d'infection, de sté rilité et une mortalité cardiovasculaire accrue. C'est dans ce contexte que de nombreuses molé cules ont é té testé es, ciblant les diffé rents mé canismes molé culaires en cause dans le dé veloppement de la NL, afin d'amé liorer le taux de ré mission et/ou de maintenir le patient en phase latente, tout en diminuant le risque d'effets secondaires.…”

A pathophysiology-based approach to the diagnosis and treatment of lupus nephritis

“…LN has numerous unmet medical needs. 54 Although its pathophysiology is beginning to be understood, significant interindividual differences exist and cannot be defined by the current histopathological categories or clinical biomarkers. In the future, genetic and molecular profiling may help to individualize risk assessment.…”