"A Change Is Gonna Come" to Treatment of Lupus Nephritis: A Review
This AJKD review outlines how lupus nephritis care is moving beyond glucocorticoids plus mycophenolate toward earlier multi-target regimens that add B-cell and T-cell directed agents such as belimumab, obinutuzumab, and voclosporin.
Background
Lupus nephritis affects up to 60% of patients with systemic lupus erythematosus, and early diagnosis and treatment are critical to preserving kidney function. Glucocorticoids combined with cyclophosphamide or mycophenolate mofetil remain the standard of care.
Key findings
Newer agents targeting B cells (belimumab, obinutuzumab) and T cells (voclosporin) have demonstrated efficacy as add-on treatments for proliferative and membranous lupus nephritis, and complement and cytokine inhibitors are under evaluation. The historical distinction between sequential induction and maintenance therapy is increasingly blurred.
Clinical implications
Personalized, multi-target regimens initiated earlier aim to improve remission and relapse rates while reducing long-term disease- and treatment-related toxicity; clinicians should weigh add-on biologic or calcineurin-inhibitor therapy against drug availability, cost, and individual patient features.
Category
Research
Source
American Journal of Kidney Diseases
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