Induction and maintenance therapy in proliferative lupus nephritis.
Authors: Ponticelli C, Glassock RJ, Moroni G
Treatment of proliferative lupus nephritis (PLN) consists of an initial aggressive treatment aimed to quench the hectic activity of the disease (induction phase) followed by a milder therapy aimed to prevent flares (maintenance treatment). There are a number of possible options for induction treatment. Intravenous (i.v.) pulses of cyclophosphamide plus oral or i.v. steroids is very effective but can be accompanied by severe adverse events. Alternatively, i.v. pulses of methylprednisolone (MPP) followed by a 2-3-month course of oral cyclophosphamide, or mycophenolate mofetil (MMF) plus prednisone, seem to be as effective as i.v. cyclophosphamide and may be better tolerated. In cases refractory to these treatments, rituximab has been used succ...