TY - JOUR
T1 - Lupus nephritis
T2 - Current treatment paradigm and unmet needs
AU - Menez, Steven P.
AU - El Essawy, Basset
AU - Atta, Mohamed G.
N1 - Publisher Copyright:
© 2018 Bentham Science Publishers.
PY - 2018
Y1 - 2018
N2 - 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.
AB - 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.
KW - Chronic kidney disease
KW - Clinical trials
KW - End-Stage Renal Disease (ESRD)
KW - Immunosuppression
KW - Kidney biopsy
KW - Systemic lupus erythematosus
UR - http://www.scopus.com/inward/record.url?scp=85048883700&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85048883700&partnerID=8YFLogxK
U2 - 10.2174/1574887112666171123113200
DO - 10.2174/1574887112666171123113200
M3 - Review article
C2 - 29173182
AN - SCOPUS:85048883700
VL - 13
SP - 105
EP - 113
JO - Reviews on Recent Clinical Trials
JF - Reviews on Recent Clinical Trials
SN - 1574-8871
IS - 2
ER -