Article

Tacrolimus is effective for lupus nephritis patients with persistent proteinuria.

Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, and Department of Internal Medicine, Fukuoka University Hospital, Fukuoka, Japan.
Clinical and experimental rheumatology (impact factor: 2.15). 28(1):6-12. pp.6-12
Source: PubMed

ABSTRACT To evaluate the safety and potential efficacy of tacrolimus for the treatment of patients with lupus nephritis and persistent proteinuria.
A total of 23 Japanese patients with lupus nephritis (21 females/2 males) were enrolled in this study. Patients were administered tacrolimus at a dose of 2-3 mg once daily after the evening meal for 6 months. The dose of tacrolimus was unchanged throughout the study period. Concomitant prednisolone therapy was unchanged or gradually tapered, while other immunosuppressants were stopped at the start of tacrolimus treatment.
Tacrolimus was well tolerated, and none of the patients developed adverse drug reactions that required discontinuation of the study. Daily urinary protein loss, the U-prot/U-creat ratio, and serum albumin were significantly improved after 4 months, 3 months, and 1 month of treatment with tacrolimus (p<0.05), respectively, and the improvement persisted until 6 months. The serum complement hemolytic activity (CH50), complement C3 level, and CRP level were also significantly improved after treatment with tacrolimus (p<0.05). Improvement of the U-prot/U-creat ratio was most prominent for patients who were in WHO class IV.
Tacrolimus is safe and effective as maintenance therapy for patients with lupus nephritis, at least for 6 months. A larger randomised, controlled trial over a longer period is needed to confirm these results.

0 0
 · 
0 Bookmarks
 · 
38 Views
  • Source
    Article: Updates on the treatment of lupus nephritis.
    Andrew S Bomback, Gerald B Appel
    [show abstract] [hide abstract]
    ABSTRACT: The treatment of lupus nephritis has changed significantly over the past decade in large part because of data from well-conducted randomized clinical trials. The concept of two phases of therapy-induction and maintenance-is widely accepted. The histopathologic classification of lupus nephritis continues to guide therapy, and treatment for all major classes of lupus nephritis has seen some shift in management during this time. New regimens using lower doses and shorter treatment durations of intravenous cyclophosphamide have been advanced to reduce toxicity without sacrificing efficacy of therapy. Mycophenolate mofetil has emerged as a viable alternative to cyclophosphamide for induction therapy of both proliferative and membranous lupus nephritis. Combination induction treatment with multiple agents has also been successful. Large controlled trials using mycophenolate mofetil and azathioprine for maintenance therapy have been performed. Here, we review recent additions to the growing body of literature on how to most effectively treat lupus nephritis with the least amount of toxicity. We discuss new treatment strategies currently being explored in clinical trials.
    Journal of the American Society of Nephrology 11/2010; 21(12):2028-35. · 9.66 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

1 month
 
21 females/2 males
 
23 Japanese patients
 
3 months
 
6 months
 
adverse drug reactions
 
C3 level
 
Concomitant prednisolone therapy
 
evening meal
 
larger randomised
 
lupus nephritis
 
maintenance therapy
 
persistent proteinuria
 
potential efficacy
 
required discontinuation
 
serum albumin
 
study period
 
tacrolimus treatment
 
U-prot/U-creat ratio
 
urinary protein loss
 

Ayumi Uchino