Cocktail of Immunosuppressant Drugs is Effective in Treating Severe Lupus Nephritis

A recent article described a multitarget therapeutic regime that was more effective than the conventional single drug approach for treating severe lupus nephritis.

Lupus nephritis is an inflammation of the kidney caused by systemic lupus erythematosus (SLE), a systemic disease of the immune system. Patients with "class V+IV” disease suffer from widespread inflammation and decreasing function of the kidneys. This severe form of lupus nephritis has been traditionally treated with a single immunosuppressant drug, but the efficacy is very poor.

In the current study, investigators from the Nanjing University School of Medicine (China) treated lupus nephritis patients with a cocktail of immunosuppressant drugs including mycophenolate mofetil, tacrolimus, and steroids (multitarget therapy).

They reported in the July 2, 2008, online edition of the Journal of the American Society of Nephrology (JASN) that 40 patients with class V+IV lupus nephritis were randomly assigned to multitarget therapy or to single drug treatment with intravenous cyclophosphamide (IVCY). Patients were treated for six months unless complete remission was not achieved, in which case treatment was extended to nine months.

Results revealed a higher rate of complete remission with multitarget therapy at both six and nine months (50 and 65%, respectively) than with IVCY (5 and 15%, respectively). At six months, eight (40%) patients in each group experienced partial remission, and at nine months, six (30%) patients receiving multitarget therapy, and eight (40%) patients receiving IVCY experienced partial remission. There were no deaths during this study. Overall, 95% of patients in the multitarget therapy group had partial or complete remission, compared to 55% with IVCY. The rate of most adverse effects was also lower with multitarget therapy.

"We considered that, since the impact of severe SLE on the kidney involves various parts of the immune system, it is necessary to treat the different immune targets with a combination of immunosuppressant drugs,” explained senior author Dr. Lei-Shi Li, professor of nephrology at Nanjing University School of Medicine. "In our study, multitarget therapy is shown to be superior to traditional therapy for inducing complete remission of class V+IV lupus nephritis, with few side effects. The therapeutic effect of our multitarget therapy is apparently superior to traditional therapy for inducing complete remission of class V+IV lupus nephritis, and also bears good tolerance under relatively lower dosages.”


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Nanjing University School of Medicine