New approaches for managing proliferative lupus nephritis

Recent research has greatly improved our understanding of the pathogenesis of systemic lupus erythematosus (SLE) and provides an insight into new targeted approaches, according to a new review.Focusing on the management of proliferative lupus nephritis (PLN) Professor Irina Buhaescu and Adrian Covic discuss strategies to improve long term outcomes and reduce treatment toxicity, while minimizing the risk of relapse.The authors consider approaches for induction and maintenance of remission together with regimens for the treatment of PLN and the management of resistant cases."The high efficacy of the standard therapeutic regimen of PLN, traditionally associating cyclophosphamide with corticosteroids, has markedly ameliorated the prognosis of the disease, with more than 80% of patients achieving complete or partial remission," the authors comment.Buhaescu and Covic add that with ten-year survival rates now surpassing 75% the major aims of treatment have shifted to include preventing long-term organ damage and minimizing treatment toxicity, "which can contribute significantly to the chronic morbidity and mortality of lupus".In addition to traditional approaches the review explores a number of newer agents and combinations which, whilst based on limited experience, "appear promising and can be considered for patients who are intolerant of refractory to the standard therapeutic regimen."However, the authors cite a number of unresolved issues such as how best to combine novel therapies for maximum benefit and the best duration of therapy.To address these issues Buhaescu and Covic call for further research, not only focusing on improving survival, but also quality of life.Reference:Buhaescu, I. and Covic, A. et al. 2007. 'Treatment of Proliferative Lupus Nephritis - A Critical Approach'. Seminars in Arthritis and Rheumatism, vol. 36, pp. 224-237.', 431, 0);"> Full Text...