The Use of Glucocorticoids in Lupus Nephritis: New Pathways for an Old Drug

Mejía-Vilet, Juan M.; Ayoub, Isabelle

doi:10.3389/fmed.2021.622225

Cited by 43 publications

(31 citation statements)

References 113 publications

(28 reference statements)

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“…NSAIDs, for example, are famous for their counter vasodilatation effect through the inhibition of the cyclooxygenase enzyme, leading to a hemodynamically mediated acute and chronic kidney injury [ 82 , 83 ]. Corticosteroids, on the other hand, although already used for the treatment of many inflammatory kidney disorders, such as IgA nephropathy, lupus nephritis, and interstitial nephritis [ 84 , 85 , 86 ], are known for their long-term and severe side-effects, which impact the kidneys—among other organs—and may hinder their consideration as a lifelong treatment, even in low doses, for nephropathic cystinosis. To this date, no prospective therapeutic clinical trial has been conducted to address the inflammatory aspect of cystinosis in human patients.…”

Section: Future Perspectivesmentioning

confidence: 99%

Nephropathic Cystinosis: Pathogenic Roles of Inflammation and Potential for New Therapies

Elmonem

Veys

Prencipe

2022

Cells

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The activation of several inflammatory pathways has recently been documented in patients and different cellular and animal models of nephropathic cystinosis. Upregulated inflammatory signals interact with many pathogenic aspects of the disease, such as enhanced oxidative stress, abnormal autophagy, inflammatory cell recruitment, enhanced cell death, and tissue fibrosis. Cysteamine, the only approved specific therapy for cystinosis, ameliorates many but not all pathogenic aspects of the disease. In the current review, we summarize the inflammatory mechanisms involved in cystinosis and their potential impact on the disease pathogenesis and progression. We further elaborate on the crosstalk between inflammation, autophagy, and apoptosis, and discuss the potential of experimental drugs for suppressing the inflammatory signals in cystinosis.

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Section: Future Perspectivesmentioning

confidence: 99%

Nephropathic Cystinosis: Pathogenic Roles of Inflammation and Potential for New Therapies

Elmonem

Veys

Prencipe

2022

Cells

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“…All the patients received 500 mg daily intravenous methylprednisolone as pulse therapy for 3 successive days and 0.6 mg/kg oral prednisone as maintenance treatment. After 6 months, the overall response rate in both groups was higher than 60% (5). A systematic review demonstrated that in comparison to the oral steroid-treated or untreated group, intravenous pulse corticosteroid therapy did not increase the risk of adverse effects, including neuropsychiatric, metabolic effect, and infectious complications (12).…”

Section: Discussionmentioning

confidence: 97%

Pulse corticosteroid therapy in the treatment of steroid-refractory immune checkpoint inhibitor-related pneumonitis: Case report and review

2022

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Immune checkpoint inhibitors (ICIs) have demonstrated promising therapeutic outcomes in treating a variety of malignancies, but immune-related adverse events (irAE) may develop. Among all the irAE, immune-related pneumonitis was relatively common and life-threatening. High-dose corticosteroid was recommended for the initial management, but a part of patients developed steroid-refractory pneumonitis. Other immunosuppressants were recommended, but the optimal treatment is still controversial. Here, we report two cases of steroid-refractory immune-related pneumonitis who were successfully treated with pulse corticosteroid therapy. Case 1 was hepatocellular carcinoma treated with nivolumab for 5 months. She developed acute respiratory distress syndrome due to grade 4 immune-related pneumonitis that was refractory to intravenous methylprednisolone 2 mg/kg/day treatment. Methylprednisolone 500 mg for 3 days followed by 2 mg/kg/day steroid as maintenance therapy was given. Subsequently, her pneumonitis was regressed, and the endotracheal tube was successfully removed on day 9 after the start of pulse therapy. Case 2 presented with grade 4 immune-related pneumonitis in spite the use of methylprednisolone 1 mg/kg for his skin rash. Pulse corticosteroid therapy was prescribed, then his pneumonitis was completely regressed on day 12. In this report, we demonstrated the potential role of pulse corticosteroid therapy for steroid-refractory pneumonitis.

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“…Los glucocorticoides tienen dos vías de acción, una vía genómica y otra no genómica (39) , con un perfil diferente en cuanto a sus mecanismos de activación y de seguridad (40) . La vía genómica se activa a partir de dosis bajas de PDN o equivalente, menores de 7,5 mg/d, y expresa su efecto antiinflamatorio en forma dosis dependiente, alcanzando una saturación cercana al 100% con dosis de 30-40 mg/d.…”

Section: Discussionunclassified

Nefritis lúpica Experiencia con dosis reducidas de glucocorticoides en una unidad de enfermedades autoinmunes sistémicas

Carlomagno

Silveira

Danza

et al. 2021

RMU

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Introducción: las recomendaciones actuales del tratamiento de la nefritis lúpica (NL) apuntan a dosis de glucocorticoides más bajas para lograr el control de la enfermedad y evitar el daño acumulado.Objetivo: conocer y comparar la respuesta al tratamiento de pacientes con NL proliferativa en su etapa de inducción con dos pautas de tratamiento con prednisona (PDN): dosis iniciales reducidas <30 mg/d y dosis iniciales estándar >30 mg/d. Método: se compararon variables clínicas, analíticas y terapéuticas de pacientes con NL proliferativa categorizados en dos grupos según la dosis inicial de prednisona (PDNi) estándar o reducida.Resultados: se estudiaron 21 pacientes con NL proliferativa (n=12 PDNi reducida vs. n=9 PDNi estándar). No hubo diferencias significativas en las variables clínicas y analíticas. Se observó una diferencia estadísticamente significativa en el número de pulsos de metilprednisolona (5 ± 2,95 PDNi <30 mg/d vs 2,33 ±2,91 PDNi >30 mg/d, p = 0,041) y en la dosis de prednisona acumulada a 6 meses (12,8 mg ± 4,9 PDNi <30 mg/d vs 30,0 ± 13,1 mg PDNi >30 mg/d, p =0,008). No hubo diferencias significativas en la proporción de pacientes que alcanzaron la respuesta completa, en el tiempo hasta alcanzarla ni en los efectos adversos entre ambos grupos.Conclusiones: el esquema terapéutico del grupo PDNi <30 mg/d se asoció a una menor dosis acumulada de prednisona y una respuesta al tratamiento comparable, lo que hace presumir menor daño acumulado relacionado al uso de glucocorticoides.

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The Use of Glucocorticoids in Lupus Nephritis: New Pathways for an Old Drug

Cited by 43 publications

References 113 publications

Nephropathic Cystinosis: Pathogenic Roles of Inflammation and Potential for New Therapies

Nephropathic Cystinosis: Pathogenic Roles of Inflammation and Potential for New Therapies

Pulse corticosteroid therapy in the treatment of steroid-refractory immune checkpoint inhibitor-related pneumonitis: Case report and review

Nefritis lúpica Experiencia con dosis reducidas de glucocorticoides en una unidad de enfermedades autoinmunes sistémicas

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