Multitarget Therapy for Induction Treatment of Lupus Nephritis

Liu, Zhihong; Zhang, Haitao; Liu, Zhangsuo; Xing, Changying; Fu, Ping; Ni, Zhaohui; Chen, Jianghua; Lin, Hongli; Liu, Fuyou; He, Yongcheng; He, Yong; Miao, Lining; Chen, Nan; Li, Ying; Gu, Yong; Shi, Wei; Hu, Weixin; Liu, Zhengzhao; Bao, Hanying; Zeng, Caihong; Zhou, Mingda

doi:10.7326/m14-1030

Cited by 316 publications

(218 citation statements)

References 38 publications

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“…At this time, CNI studies need to be viewed cautiously. Unexpectedly, in the multitarget study patient withdrawals due to adverse events were higher in the CNI arm than the cyclophosphamide arm (97). The effects of CNIs in more racially and ethnically diverse cohorts must be studied.…”

Section: Other Emerging Therapiesmentioning

confidence: 96%

“…CNIs attenuate inflammation by preventing release of inflammatory cytokines from leukocytes, and also block T cell activation (96), and therefore could have an effect to maintain remission. CNIs have been used as part of a multitarget approach to treating LN, added to a regimen of MMF and corticosteroids, and have been shown to be superior to cyclophosphamide in inducing remission by 6 months (97). A multitarget approach is appealing as the pathogenesis of SLE involves several immune pathways.…”

Section: Other Emerging Therapiesmentioning

confidence: 99%

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Update on Lupus Nephritis

Almaani

Meara

Rovin

2016

CJASN

624

483

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SLE is a chronic inflammatory disease that affects the kidneys in about 50% of patients. Lupus nephritis is a major risk factor for overall morbidity and mortality in SLE, and despite potent anti-inflammatory and immunosuppressive therapies still ends in CKD or ESRD for too many patients. This review highlights recent updates in our understanding of disease epidemiology, genetics, pathogenesis, and treatment in an effort to establish a framework for lupus nephritis management that is patient-specific and oriented toward maintaining long-term kidney function in patients with lupus.

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Section: Other Emerging Therapiesmentioning

confidence: 96%

Section: Other Emerging Therapiesmentioning

confidence: 99%

Update on Lupus Nephritis

Almaani

Meara

Rovin

2016

CJASN

624

483

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“…The "multi-target" treatment regimen consisted of an upfront combination of tacrolimus and MMF (1 g/day). 18 The dosage of tacrolimus was adjusted to maintain its blood levels 12 h after administration in the range 5-10 ng/mL. Dose adjustments were made as necessary in case of drug toxicity or intolerance.…”

Section: Is Treatment Regimensmentioning

confidence: 99%

Predictors of Favorable Responses to Immunosuppressive Treatment in Pulmonary Arterial Hypertension Associated With Connective Tissue Disease

Yasuoka

Shirai

Tamura

et al. 2018

Circ J

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Background:The potential efficacy of immunosuppressive (IS) treatment has been reported in patients with pulmonary arterial hypertension (PAH) associated with connective tissue disease (CTD), but its positioning in the treatment algorithm remains uncertain. The aim of this study was to identify predictors of favorable responses to first-line IS treatment. Methods and Results:This single-center retrospective study included 30 patients with PAH accompanied by systemic lupus erythematosus (SLE), mixed CTD (MCTD), or primary Sjögren's syndrome (SS) who received first-line IS treatment alone or in combination with pulmonary vasodilators. When short-term treatment response was defined as an improvement in World Health Organization functional class at 3 months, 16 patients (53%) were short-term responders. Simultaneous diagnosis of PAH and CTD, and the use of immunosuppressants, especially intravenous cyclophosphamide, in addition to glucocorticoids were identified as independent predictors of a short-term response (P=0.004 and 0.0002, respectively). Cumulative rates free of PAH-related death were better in short-term responders than non-responders (P=0.04), and were best in patients with a simultaneous diagnosis of PAH and CTD who were treated initially with a combination of glucocorticoids and immunosuppressants. Conclusions:Patients with a simultaneous diagnosis of PAH and CTD, including SLE, MCTD, and primary SS, should receive intensive IS treatment regimens to achieve better short-and long-term outcomes.

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“…Tacrolimus and rapamycin (sirolimus) are non-antimicrobial macrolides widely used in transplantation medicine. Though there is no evidence for the use of these agents in AAV, recent trials support the use of tacrolimus as an adjunct in the treatment of lupus nephritis [14]. Experimental evidence also suggests a role for rapamycin in the treatment of rapidly progressive glomerulonephritis [15].…”

Section: Discussionmentioning

confidence: 99%

Macrolide Therapy and Alveolar Hemorrhage Secondary to Granulomatosis With Polyangiitis

Greenhall¹,

Vancheeswaran²,

Burns³

2015

J Vasc

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We report the case of a 64-year-old woman with severe alveolar haemorrhage secondary to granulomatosis with polyangiitis (GPA), who was unknowingly treated with only penicillin and macrolide antibiotics, resulting in successful initial disease remission. The immunomodulatory effects of the macrolide antibiotic used could underlie this novel observation, which may shed new light on the pathogenesis and potential treatment of anti-neutrophil cytoplasm antibody (ANCA) associated vasculitis. The role of macrolides as an adjunct to conventional therapy in cases of AAV with respiratory involvement may be worthy of further investigation.

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Multitarget Therapy for Induction Treatment of Lupus Nephritis

Abstract: National Basic Research Program of China, National Key Technology R&D Program.

Cited by 316 publications

References 38 publications

Update on Lupus Nephritis

Update on Lupus Nephritis

Predictors of Favorable Responses to Immunosuppressive Treatment in Pulmonary Arterial Hypertension Associated With Connective Tissue Disease

Macrolide Therapy and Alveolar Hemorrhage Secondary to Granulomatosis With Polyangiitis

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