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Lupus Nephritis: Current Treatment Paradigm and Unmet Needs

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Menez SP1, El Essawy B2, Atta MG1. Rev Recent Clin Trials. 2017 Nov 22. doi: 10.2174/1574887112666171123113200. [Epub ahead of print]


1 Johns Hopkins Department of Medicine, Division of Nephrology, Baltimore, MD. United States.

2 Al-Azhar University- Department of Medicine, Nephrology Unit. Egypt.


BACKGROUND: Systemic lupus erythematosus (SLE) is an autoimmune disorder characterized by chronic inflammation, which can result in a multitude of systemic or organ-limited manifestations, including the skin, lungs, heart, and kidney. SLE nephritis is present in an average of 38% of patients at the time of diagnosis, and may occur as the initial presentation of disease with progression to end-stage renal disease (ESRD) in roughly 10-20% of patients.

METHODS: A review of the current literature was undertaken to investigate the evolution of treatment of SLE nephritis based on randomized trials and robust observational studies. We aimed to provide a timeline of the development of current induction and maintenance therapy, as well as the development of novel targeted therapies, all leading to current guidelines.

RESULTS: Based on all available current data on standard of care therapies for SLE nephritis, there is at best a complete remission rate of 50-60%, and roughly 13-25% of patients experience periods of relapse during maintenance therapy for SLE nephritis. Therefore, the need for newer, targeted therapies has been the focus of many current, ongoing clinical trials.

CONCLUSION: Standard induction and maintenance therapies at present are anti-proliferative and non-specific, that is, interfering with the process of autoantigen presentation and activation of autoreactive leukocytes. However, newer agents with specific T-cell, B-cell, or proteasome targets are currently being investigated.