Therapy of lupus nephritis: lessons learned from clinical research and daily care of patients
Rheumatology Department, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Avenue Hippocrate, 10, B-1200 Bruxelles, Belgium
Arthritis Research & Therapy 2012, 14:202 doi:10.1186/ar3656Published: 31 January 2012
Despite numerous randomized clinical trials over the last three decades for identifying the optimal treatment option for lupus nephritis, renal involvement still significantly impacts the survival and quality of life of patients with lupus and the search for the ideal immunosuppressive regimen is far from complete. The purpose of this review is to summarize the major recent achievements in the field. More specifically, the following topics will be discussed: intravenous cyclophosphamide versus mycophenolate mofetil (MMF) for induction; azathioprine versus MMF for maintenance; targeted therapies. The review will address clues for optimal global care, such as the need for complete initial evaluation, the importance of patient education, the unmasking of non-compliance to therapy, the reason for an early treatment switch in non-responding patients, the need for prolonged immunosuppression, optimal renal protection, and prevention of cardiovascular disease and other comorbidities.