Drugs

, Volume 66, Issue 9, pp 1191–1207

Pharmacotherapy of Lupus Nephritis in Children

A Recommended Treatment Approach
  • Alexa Adams
  • Emma Jane MacDermott
  • Thomas J. A. Lehman
Therapy in Practice

Abstract

Systemic lupus erythematosus (SLE) is a multisystem inflammatory disease of unknown aetiology, which is characterised by recurrent disease flares that may affect any organ system. Renal involvement remains one of the chief causes of morbidity and mortality in children with lupus. Nephritis occurs in approximately two-thirds of patients, ranging from mild glomerulitis to life-threatening occurrences of diffuse proliferative glomerulonephritis. As lupus nephritis is a condition of no single aetiology, there is no single cure. Corticosteroids, although still the first line of treatment, are increasingly being superseded by cytotoxic drugs, in particular cyclophosphamide and corticosteroid-sparing agents. Newer agents such as mycophenolate mofetil, although effective in the treatment of lupus in adults, are less effective in children. Standard of care for highly active lupus nephritis in children remains intravenous cyclophosphamide, although preliminary experience suggests that the addition of rituximab may allow for remission induction with a reduction in cumulative cyclophosphamide dose. Combination therapies and newer agents appear promising for the future as our understanding of the immune system and its dysregulation in SLE improves. In this review, we discuss the current standards of care, newer therapies currently in use, and emerging treatments still undergoing development and investigation. We conclude by discussing our guidelines for treatment at the present time and suggestions for the comprehensive care of children with lupus nephritis.

Copyright information

© Adis Data Information BV 2006

Authors and Affiliations

  • Alexa Adams
    • 1
  • Emma Jane MacDermott
    • 1
  • Thomas J. A. Lehman
    • 1
    • 2
  1. 1.Division of Pediatric RheumatologyHospital for Special SurgeryNew YorkUSA
  2. 2.Department of PediatricsWeill Cornell Medical CenterUSA

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