Steven P Menez 1 , Basset El Essawy 2 , Mohamed G Atta 1 Show Affiliations »
Abstract
BACKGROUND: Systemic Lupus Erythematosus (SLE) is an autoimmune disorder characterized by chronic inflammation, which can result in a multitude of systemic or organ-limited manifestations, including the skin, lungs, heart, and kidney. SLE nephritis is present in an average of 38% of patients at the time of diagnosis, and may occur as the initial presentation of disease with progression to End-Stage Renal Disease (ESRD) in roughly 10-20% of patients. METHODS: A review of the current literature was undertaken to investigate the evolution of treatment of SLE nephritis based on randomized trials and robust observational studies. We aimed to provide a timeline of the development of current induction and maintenance therapy, as well as the development of novel targeted therapies, all leading to current guidelines. RESULTS: Based on all available current data on standard of care therapies for SLE nephritis, there is at best a complete remission rate of 50-60%, and roughly 13-25% of patients experience periods of relapse during maintenance therapy for SLE nephritis. Therefore, the need for newer, targeted therapies has been the focus of many current, ongoing clinical trials. CONCLUSION: Standard induction and maintenance therapies at present are anti-proliferative and nonspecific, that is, interfering with the process of autoantigen presentation and activation of autoreactive leukocytes. However, newer agents with specific T-cell, B-cell, or proteasome targets are currently being investigated. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.
BACKGROUND: Systemic Lupus Erythematosus (SLE ) is an autoimmune disorder characterized by chronic inflammation , which can result in a multitude of systemic or organ-limited manifestations, including the skin, lungs, heart, and kidney. SLE nephritis is present in an average of 38% of patients at the time of diagnosis, and may occur as the initial presentation of disease with progression to End-Stage Renal Disease (ESRD ) in roughly 10-20% of patients . METHODS: A review of the current literature was undertaken to investigate the evolution of treatment of SLE nephritis based on randomized trials and robust observational studies. We aimed to provide a timeline of the development of current induction and maintenance therapy, as well as the development of novel targeted therapies, all leading to current guidelines. RESULTS: Based on all available current data on standard of care therapies for SLE nephritis , there is at best a complete remission rate of 50-60%, and roughly 13-25% of patients experience periods of relapse during maintenance therapy for SLE nephritis . Therefore, the need for newer, targeted therapies has been the focus of many current, ongoing clinical trials. CONCLUSION: Standard induction and maintenance therapies at present are anti-proliferative and nonspecific, that is, interfering with the process of autoantigen presentation and activation of autoreactive leukocytes. However, newer agents with specific T-cell, B-cell, or proteasome targets are currently being investigated. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.
Entities: Disease
Species
Keywords:
Chronic kidney disease; End-Stage Renal Disease (ESRD); clinical trials; immunosuppression; kidney biopsy; systemiczzm321990lupus erythematosus.
Mesh： See more »
Year: 2018
PMID： 29173182 DOI： 10.2174/1574887112666171123113200
Source DB: PubMed Journal: Rev Recent Clin Trials ISSN： 1574-8871