Tacrolimus Shows Benefits in Class V Lupus Nephritis

Treatment with the immunosuppressive drug tacrolimus hastens recovery in systemic lupus erythematosus (SLE) patients with pure membranous (class V) nephropathy, according to a preliminary study in Rheumatology.

C.-C. Szeto, MD, and colleagues of the Chinese University of Hong Kong performed an open-label study in 18 patients with SLE and biopsy-confirmed class V lupus nephritis. In addition to a tailing dose of prednisolone, all patients received tacrolimus, 0.1 to 0.2 mg/kg/d. After 6 months, patients received maintenance therapy with prednisolone and azathioprine. Outcomes were compared with historical controls treated with cyclophosphamide or azathioprine.

By 12 weeks, proteinuria had decreased by 76.2 percent in the tacrolimus group, compared to 47.1 percent in the historical control group. There were no major differences in remission rates; changes in renal function and SLE disease activity were similar between groups. Lupus flares occurred in 4 of 18 patients in the tacrolimus group versus 11 of 19 in the control group.

The results suggest that tacrolimus may offer a safe and effective alternative to conventional cytotoxic therapy for patients with pure membranous lupus nephropathy, including faster resolution of proteinuria and a lower risk of lupus flare. More study is needed to define the long-term benefit and optimal regimen of tacrolimus [Szeto C-C, Kwan BC-H, Lai FM-M, Tam L-S, Li EK-M, Chow K-M, Gang W and Li PK-T: Tacrolimus for the treatment of systemic lupus erythematosus with pure class V nephritis. Rheumatology, 2008; 47:1678–1681].