Abstract
Objectives. 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).
Methods. 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).
Results. 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, p = 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%, p = 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.
Conclusions. 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.
Funding
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Conflicts of interest
H Ikeuchi has received research grants from Chugai Pharmaceutical, Co., Ltd. K Hiromura has received honoraria for lectures and research grants from Astellas Pharma Inc. Y Nojima has received honoraria for lectures and research grants from Astellas Pharma Inc and research grants from Chugai Pharmaceutical, Co., Ltd. All other authors have declared no conflicts of interest.