Efficacy and safety of multi-target therapy using a combination of tacrolimus, mycophenolate mofetil and a steroid in patients with active lupus nephritis. Issue 4 (July 2014)

• Record Type: Journal Article
• Authors: Ikeuchi, Hidekazu; Hiromura, Keiju; Takahashi, Satoshi; Mishima, Keiichiro; Sakurai, Noriyuki; Sakairi, Toru; Kaneko, Yoriaki; Maeshima, Akito; Kuroiwa, Takashi; Nojima, Yoshihisa
• Is Part Of: Modern rheumatology. Volume 24:Issue 4(2014)
• Page Start: 618
• Page End: 625
• Publication Date: 2014-07
• Subjects: Rheumatology -- Periodicals; 616.723005
• DOI: 10.3109/14397595.2013.844397
• Languages: English
• ISSNs: 1439-7595

Abstract

<abstract> <title>Abstract</title> <p> <italic>Objectives.</italic> To examine the efficacy and safety of multi-target therapy using tacrolimus (TAC), mycophenolate mofetil (MMF) and a steroid as initial treatment for active lupus nephritis (LN).</p> <p> <italic>Methods.</italic> We conducted a retrospective analysis of the data of 16 consecutive patients who received the multi-target therapy for active Classes III–V LN at our department. We also compared the outcomes of the multi-target therapy with those of TAC therapy (TAC + steroid), a study of which we had conducted previously in 13 patients with active LN (TAC group).</p> <p> <italic>Results.</italic> All the patients treated with multi-target therapy achieved complete remission (CR) (mean, 4.6 ± 3.8 months; range, 1–15 months). The clinical profiles of the patients of the multi-target group were similar to those of the TAC group at baseline, except for a significantly higher level of proteinuria (4.6 ± 2.8 vs. 2.5 ± 2.1 g/gCr, <italic>p</italic> = 0.033) in the former. The CR rate at 6 months was significantly higher in the multi-target group as compared with that in the TAC group (81% vs. 38%, <italic>p</italic> = 0.018). Two cases of serious adverse events were associated with cytomegalovirus infection in the multi-target group, namely gastric ulcer and pancytopenia, both of which were successfully treated by antiviral therapy.</p> <p> <italic>Conclusions.</italic> Multi-target therapy was effective as initial treatment for active LN, with CR achieved early and in a high percentage of patients. Although this therapy was generally well tolerated, it is important to bear in mind the associated risk of cytomegalovirus infection.</p> </abstract>