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Abstract
Background The standard treatment of lupus nephritis is based on immunosuppressive therapy using mycophenolate mofetil or cyclophosphamide and with glucocorticoids, however, these treatments are not consistently effective. Tacrolimus (TAC), a novel calcineurin inhibitor with immunosuppressive effects, has recently become increasingly interested in its role as a potential therapeutic agent in SLE. We aimed to evaluate the efficacy of TAC as a treatment for LN.
Methods A total 170 patients with biopsy proven LN were enrolled by reviewing the medical records of patients with LN in Ajou Lupus cohort. The clinical response of TAC treatment was evaluated by proteinuria, estimated glomerular filtration rate (eGFR), anti-double-stranded DNA (anti-dsDNA) antibody, complement 3 (C3), complement 4 (C4), and renal SLE disease activity index (SLEDAI). Complete renal response was defined as urine protein to creatinine ratio <0.5, normal serum creatinine or, if normal at baseline, not increased by ≥15%, and partial renal response was defined as a normal or near-normal GFR with a ≥50% reduction in proteinuria to sub-nephrotic levels. The definition of poor outcomes was determined by end stage renal disease or death.
Results The baseline clinical manifestations between 92 TAC group and 87 non-TAC group showed no significant differences. Most of TAC group received multi-target therapy with other immunosuppressants, while the non-TAC group usually used monotherapy. After 5 years, there were no statistically significant differences in proteinuria, eGFR levels, anti-dsDNA, serum C3/C4, and renal SLEDAI. The overall (complete and partial) renal response rate was not significantly different (TAC group versus non-TAC group=72.9% versus 85.5%; p=0.1). The poor outcomes were similar in both groups (log-rank p=0.837).
Conclusions TAC is an effective maintenance therapy for LN, and may be a reasonable option for patients with refractive LN or LN who have not reached remission. In conclusion, TAC can help patients with LN achieve a renal response and slow progression.
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