The safety of pharmacological treatment options for lupus nephritis

Velo-García, Alba; Ntatsaki, Eleana; Isenberg, David

doi:10.1080/14740338.2016.1182496

Cited by 7 publications

(7 citation statements)

References 101 publications

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“…CYC may be taken orally or intravenously, but IV pulse is preferred due to its superior efficacy-to-toxicity ratio [ 2 ]. Daily oral CYC as induction therapy may be more effective than intravenous pulses; however, its greater ovarian toxicity makes it justified only in high-risk or refractory LN [ 2 ]. Moreover, some studies suggest that CYC may have efficacy differences between different races of people [ 135 ].…”

Section: Cyclophosphamide (Cyc)mentioning

confidence: 99%

“…Due to the risk of gonadal insufficiency, therapeutic alternatives, such as biologics, are suggested in patients of childbearing age. However, if CYC must be used, gonadotropin-releasing hormone analogs (GNRHa) should be combined with treatment [ 2 ]. GnRHa can exert direct protective effects on the ovaries through peripheral GnRH receptors and significantly reduce the risk of ovarian failure in young women with severe SLE [ 149 ].…”

Section: Cyclophosphamide (Cyc)mentioning

confidence: 99%

“…However, all pharmacological alternatives can potentially precipitate adverse reactions, which is why risk management programs that evaluate the safety and efficacy of treatments must be an integral part of the selection and during therapy. A wide variety of drugs are available; therapy choice depends on many diverse factors, such as organ systems compromised, disease activity, previous therapy response, desire for parenthood, pregnancy or lactation, contraindications, and therapy adherence [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

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Synthetic Pharmacotherapy for Systemic Lupus Erythematosus: Potential Mechanisms of Action, Efficacy, and Safety

et al. 2022

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The pharmacological treatment of systemic lupus erythematosus (SLE) aims to decrease disease activity, progression, systemic compromise, and mortality. Among the pharmacological alternatives, there are chemically synthesized drugs whose efficacy has been evaluated, but which have the potential to generate adverse events that may compromise adherence and response to treatment. Therapy selection and monitoring will depend on patient characteristics and the safety profile of each drug. The aim of this review is to provide a comprehensive understanding of the most important synthetic drugs used in the treatment of SLE, including the current treatment options (mycophenolate mofetil, azathioprine, and cyclophosphamide), review their mechanism of action, efficacy, safety, and, most importantly, provide monitoring parameters that should be considered while the patient is receiving the pharmacotherapy.

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Section: Cyclophosphamide (Cyc)mentioning

confidence: 99%

Section: Cyclophosphamide (Cyc)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Synthetic Pharmacotherapy for Systemic Lupus Erythematosus: Potential Mechanisms of Action, Efficacy, and Safety

et al. 2022

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“… 81 , 82 These polymorphisms are present in 10% of Caucasian, and whose homozygous defect is present in less than 1%. 83 , 84 …”

Section: Azathioprinementioning

confidence: 99%

Mechanism of Action and Efficacy of Immunosupressors in Lupus Nephritis

Alamilla-Sánchez¹,

MA²,

Alonso-Bello³

et al. 2021

IJNRD

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Approximately 70% of the patients with systemic lupus erythematosus will have clinical evidence of kidney damage during their evolution. Patients with impaired renal function at onset and those with recurrent flares have a poor prognosis. Understanding the mechanism of action of immunosuppressants is essential for proper prescription. Steroids inhibit the DNA sequence that promotes the release of inflammatory cytokines. Phosphoramide mustard, metabolite of cyclophosphamide, cross-link with the DNA, causing the aggregation of an alkyl group, causing cell death. Mycophenolate inhibits inosine monophosphate dehydrogenase, prevents de novo synthesis of guanine, inducing cell arrest in S phase. Azathioprine blocks the synthesis of purines and induces apoptosis. Calcineurin inhibitors prevent the dephosphorylation of NFAT and reduce the production of interleukin 2. Antimalarials alter the enzymatic release of lysosomes by increasing intravesicular pH. The mechanism of action of rituximab is related to complement-dependent cytotoxicity and the elimination of anti-CD20-labeled B cells. Progress in the knowledge and management of low doses of steroids may change the current paradigm and reduce the frequency of related adverse events. Mycophenolate seems to be a better choice than cyclophosphamide for induction, it is also preferred over azathioprine as a maintenance immunosuppressive agent, although azathioprine is preferred in women with a desire for conception, those pregnant, or with low resources. For treatment-resistant cases, tacrolimus, rituximab or belimumab may be effective. Ongoing clinical trials with new drugs offer promising results.

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“…The majority of patients with SLE have low serum levels of 25‐hydroxyvitamin D (calcifediol), probably due to avoidance of sun exposure and/or use of sunscreen products. Vitamin D levels should be monitored periodically and patients with low vitamin D levels should be treated with supplemental vitamin D. This measure is important to help counter the increased risk of osteoporosis associated with corticosteroid use …”

Section: Immunologymentioning

confidence: 99%