Lupus nephritis: Current treatment paradigm and unmet needs

Steven Menez, Basset El Essawy, Mohamed Atta

Research output: Contribution to journalReview articlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)105-113
Number of pages9
JournalReviews on Recent Clinical Trials
Volume13
Issue number2
DOIs
StatePublished - Jan 1 2018

Keywords

  • Chronic kidney disease
  • Clinical trials
  • End-Stage Renal Disease (ESRD)
  • Immunosuppression
  • Kidney biopsy
  • Systemic lupus erythematosus

ASJC Scopus subject areas

  • Pharmacology

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