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Lupus nephritis

Comparison of induction therapies for lupus nephritis

Nature Reviews Nephrology volume 8, page 62 (2012)Cite this article

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Induction therapy for the treatment of proliferative lupus nephritis has traditionally involved cyclophosphamide; however, this agent is associated with various adverse effects, including gonadal toxicity. Researchers have now reported findings from a long-term follow-up comparison of two different induction therapies—azathioprine plus methylprednisolone versus high-dose intravenous cyclophosphamide—and report that treatment with azathioprine and methylprednisolone may be an alternative for particular patients who wish to avoid gonadal toxicity.

The first Dutch Lupus Nephritis Study was initiated in 1995. The researchers randomly allocated 87 patients with proliferative lupus nephritis to receive either azathioprine plus intravenous methylprednisolone and oral prednisone (n = 37), or intravenous cyclophosphamide and oral prednisone (n = 50). After 2 years, all patients received azathioprine plus oral prednisone. In addition, the researchers regularly obtained clinical and laboratory data and performed renal biopsies in all 87 patients before randomization and in 41 patients after 2 years to evaluate predictors of renal outcome. “Identifying prognostic factors for outcome after immunosuppressive treatment is important for optimizing treatment strategies in individual patients with lupus nephritis”, explains Suzanne Arends from the study group.

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ORIGINAL RESEARCH PAPER

  1. Arends, S. et al. Long-term follow-up of a randomised controlled trial of azathioprine/methylprednisolone versus cyclophosphamide in patients with proliferative lupus nephritis. Ann. Rheum. Dis. doi:10.1136/annrheumdis-2011-200384

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  1. Susan J. Allison
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Allison, S. Comparison of induction therapies for lupus nephritis. Nat Rev Nephrol 8, 62 (2012). https://doi.org/10.1038/nrneph.2011.203

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