Video: Every Case Tells a Story| Webinar: ACR/CHEST ILD Guidelines in Practice

An official publication of the ACR and the ARP serving rheumatologists and rheumatology professionals

  • Conditions
    • Axial Spondyloarthritis
    • Gout and Crystalline Arthritis
    • Myositis
    • Osteoarthritis and Bone Disorders
    • Pain Syndromes
    • Pediatric Conditions
    • Psoriatic Arthritis
    • Rheumatoid Arthritis
    • Sjögren’s Disease
    • Systemic Lupus Erythematosus
    • Systemic Sclerosis
    • Vasculitis
    • Other Rheumatic Conditions
  • FocusRheum
    • ANCA-Associated Vasculitis
    • Axial Spondyloarthritis
    • Gout
    • Psoriatic Arthritis
    • Rheumatoid Arthritis
    • Systemic Lupus Erythematosus
  • Guidance
    • Clinical Criteria/Guidelines
    • Ethics
    • Legal Updates
    • Legislation & Advocacy
    • Meeting Reports
      • ACR Convergence
      • Other ACR meetings
      • EULAR/Other
    • Research Rheum
  • Drug Updates
    • Analgesics
    • Biologics/DMARDs
  • Practice Support
    • Billing/Coding
    • EMRs
    • Facility
    • Insurance
    • QA/QI
    • Technology
    • Workforce
  • Opinion
    • Patient Perspective
    • Profiles
    • Rheuminations
      • Video
    • Speak Out Rheum
  • Career
    • ACR ExamRheum
    • Awards
    • Career Development
  • ACR
    • ACR Home
    • ACR Convergence
    • ACR Guidelines
    • Journals
      • ACR Open Rheumatology
      • Arthritis & Rheumatology
      • Arthritis Care & Research
    • From the College
    • Events/CME
    • President’s Perspective
  • Search

Immunosuppressive Treatment for Lupus in the Next Decade

Dimitrios T. Boumpas, MD; George Bertsias, MD  |  Issue: April 2011  |  April 13, 2011

Immunosuppressive Therapy in Lupus

Today most experts agree that the treatment of severe lupus involves a period of intensive immunosuppressive therapy aimed at halting immunological injury (induction therapy), followed by a period of less aggressive maintenance therapy to maintain the response. The latter period is essential to prevent flares and organ damage accrual. Although this strategy seems logical, it has not been formally tested against a “wait and treat the flare” approach.

Studies dating back to as far as the 1960s clearly demonstrated that high-dose glucocorticoids were not effective in halting end-stage renal disease (ESRD) in proliferative lupus nephritis (LN), with most patients requiring hemodialysis after five to 10 years. This observation, coupled with an increased awareness of steroid toxicity, provided the impetus in subsequent years to explore alternative immunosuppressive agents with an emphasis on AZA and CY. In these trials, most of the data originated from two centers in the United States: Mayo Clinic and the National Institutes of Health (NIH).

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

Azathioprine

Early studies by Hahn et al failed to demonstrate a significant effect of AZA on severe disease when added to glucocorticoids in early treatment.1 Subsequent studies by the NIH group showed only a trend to superiority of AZA with prednisone over prednisone alone; the studies, however, may have lacked power to detect a smaller treatment effect.2 Nevertheless, these results have led to considerable decrease in the usage of AZA for LN with the exception of some pediatric centers in Canada.

More recently, new studies have given us the opportunity to take another look into the effectiveness of AZA in the context of new therapeutic protocols and a modern standard of care. In a recent head-to-head comparison of AZA with intravenous CY (IV-CY), AZA showed comparable efficacy after a mean follow-up of at least five years.3 The use of intravenous methylprednisolone (IV-MP) pulses at the beginning of treatment for all patients in this study may have improved the performance of AZA. Strong, albeit circumstantial, evidence supports the use of one to three IV-MP pulses especially in patients with moderate or severe nephritis; in addition to expediting remission, IV-MP pulses may allow for the use of lower doses of glucocorticoids during the induction phase. Not surprisingly, patients in the AZA group experienced more flares and progression of scarring in repeat renal biopsies.3,4 Of note, the study involved only European, low-to-moderate–risk patients (see Figure 2 for definitions) treated in a context of the European healthcare system.

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

Page: 1 2 3 4 5 6 7 8 | Single Page
Share: 

Filed under:ConditionsDrug UpdatesSystemic Lupus Erythematosus Tagged with:Diagnostic CriteriaDrugsPathogenesispatient careSystemic lupus erythematosusTreatment

Related Articles

    Reading Rheum

    April 1, 2009

    Handpicked Reviews of Contemporary Literature

    Tacrolimus Use for Lupus Nephritis Raises Debate over Role in North American Population

    October 10, 2016

    The following summary regarding use of tacrolimus (TAC) in lupus nephritis highlights a number of debatable points. Although the role of TAC in lupus nephritis remains unproved for North American populations, it might be an excellent option in some clinical situations. These situations include lupus flare during pregnancy and also for lupus nephritis when the…

    Reading Rheum

    October 1, 2009

    Handpicked Reviews of Contemporary Literature

    Best Lupus Treatment Still Up for Debate

    December 1, 2009

    Panel looks at decision making for treatment of three high-risk patients

  • About Us
  • Meet the Editors
  • Issue Archives
  • Contribute
  • Advertise
  • Contact Us
  • Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 1931-3268 (print). ISSN 1931-3209 (online).
  • DEI Statement
  • Privacy Policy
  • Terms of Use
  • Cookie Preferences