Lupus Nephritis: Current Treatment Paradigm and Unmet Needs

摘要

Background: Systemic Lupus Erythematosus (SLE) is an autoimmune disorder characterizedby 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 patientsat the time of diagnosis, and may occur as the initial presentation of disease with progression toEnd-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 ofSLE nephritis based on randomized trials and robust observational studies. We aimed to provide atimeline of the development of current induction and maintenance therapy, as well as the developmentof 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 atbest a complete remission rate of 50-60%, and roughly 13-25% of patients experience periods of relapseduring maintenance therapy for SLE nephritis. Therefore, the need for newer, targeted therapieshas 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 autoreactiveleukocytes. However, newer agents with specific T-cell, B-cell, or proteasome targets are currently beinginvestigated.