Lupus Nephritis - Treatment

Treatment

The medical therapy for lupus nephritis depends on the severity of the disease. For mild disease, corticosteroids are, in general, prescribed. More severe disease requires treatment with immunosuppressant agents. The two most commonly used agents are mycophenolate mofetil and intravenous cyclophosphamide. One recent study compared these two drugs. The authors showed that patients with Class III or IV disease are more likely to benefit from mycophenolate mofetil as compared to cyclophosphamide. However, a larger study by the same authors that directly compared these therapies did not show that Mycophenolate was superiour to cyclophosphamide except in non-caucasian non-Asian patients . In caucasian or Asian patients both treatments worked equally well. Both agents are associated with significant adverse effects; cyclophosphamide may induce permanent infertility in young women, and mycophenolate mofetil is associated with a higher risk of infection-related death. One study concluded that in cases where lupus-related thrombotic thrombocytopenic purpura is present, plasmapheresis is life-saving, and must be instituted early to avoid a poor outcome. PMID 14530532.

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