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Drugs
Published in: Drugs 9/2006

01-06-2006 | Therapy in Practice

Pharmacotherapy of Lupus Nephritis in Children

A Recommended Treatment Approach

Authors: Alexa Adams, Emma Jane MacDermott, Dr Thomas J. A. Lehman

Published in: Drugs | Issue 9/2006

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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 Corticosteroids, although still the first line of treatment, are increasingly being superseded by cytotoxic drugs, in particular cyclophosphamide and corticosteroid-sparing agents.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.
Literature
1.
Cassidy JT, Petty RE. Textbook of pediatric rheumatology. 4th ed. Philadelphia (PA): WB Saunders Company, 2001
2.
Hochberg M. The incidence of systemic lupus erythematosus in Baltimore, Maryland, 1970–1977. Arthritis Rheum 1985; 28: 80–6PubMedCrossRef
3.
Siegel M, Lee ML. The epidemiology of systemic lupus erythematosus. Semin Arthritis Rheum 1973; 3: 1–54PubMedCrossRef
4.
Lehman TJA, McCurdy DK, Bernstein BH, et al. Systemic lupus in the first decade of life. Pediatrics 1989 Feb; 83(2): 235–9PubMed
5.
6.
McCurdy DK, Lehman TJ, Bernstein B, et al. Lupus nephritis: prognostic factors in children. Pediatrics 1992; 89(2): 240–6PubMed
7.
Hagelberg S, Lee Y, Bargman J, et al. Longterm followup of childhood lupus nephritis. J Rheumatol 2002 Dec; 29(12): 2635–42PubMed
8.
Spahn JD, Kamada AK. Special considerations in the use of glucocorticoids in children. Pediatr Rev 1995; 16: 266–72PubMedCrossRef
9.
Satel SL. Mental status changes in children receiving glucocorticoids. Clin Pediatr (Phila) 1990; 29: 382–8CrossRef
10.
11.
12.
McCarthy TL, Centrella M, Canalis E. Cortisol inhibits the synthesis of insulin-like growth factor 1 in skeletal cells. Endocrinology 1990; 126: 1569–75PubMedCrossRef
13.
Lehman TJA, Mouradian JA. Systemic lupus erythematosus. In: Holliday M, Barratt M, Avner ED, editors. Pediatric nephrology. 4th ed. Baltimore (MD): William and Wilkins, 1999
14.
Ilowite NT, Samuel P, Ginzler E, et al. Dyslipoprotienemia in pediatric systemic lupus erythematosus. Arthritis Rheum 1988 Jul; 31(7): 859–63PubMedCrossRef
15.
Ilowite NT. Premature Atherosclerosis in systemic lupus erythematosus. J Rheumatol Suppl 2000 Apr; 58: 15–9PubMed
16.
Barron KS, Person DA, Brewer EJ, et al. Pulse methylprednisolne therapy in diffuse proliferative lupus nephritis. J Pediatr 1982 Jul; 101(1): 137–41PubMedCrossRef
17.
Garin EH, Sleasman JW, Richard GA, et al. Pulsed methylprednisolone therapy compared to high dose prednisone in systemic lupus erythematosus nephritis. Eur J Pediatr 1986 Oct; 145(5): 380–3PubMedCrossRef
18.
Lehman TJ, Sherry DD, Wagner-Weiner L, et al. Intermittent intravenous cyclophosphamide therapy for lupus nephritis. J Pediatr 1989 Jun; 114(6): 1055–60PubMedCrossRef
19.
Lehman TJ, Onel K. Intermittent intravenous cyclophosphamide arrests progression of the renal chronicity index in childhood systemic lupus erythematosus. J Pediatr 2000 Feb; 136(2): 243–7PubMedCrossRef
20.
Lehman TJ, Edelheit BS, Onel KB. Combined intravenous methotrexate and cyclophosphamide for refractory childhood lupus nephritis. Ann Rheum Dis 2004; 63: 321–3PubMedCrossRef
21.
Silverman GJ, Weisman S. Rituximab therapy and autoimmune disorders: prospects for anti-B cell therapy. Arthritis Rheum 2003 Jun; 48(6): 1484–92PubMedCrossRef
22.
Looney RJ, Anolik JH, Campbell D, et al. B-cell depletion as a novel treatment for systemic lupus erythematosus: a phase I/II dose escalation trial of Rituximab. Arthritis Rheum 2004 Aug; 50(8): 2580–9PubMedCrossRef
23.
Sfikakis PP, Boletis JN, Lionaki S, et al. Remission of proliferative lupus nephritis following B-cell depletion therapy is preceded by down regulation of the T-cell costimulatory molecule CD40 ligand: an open label trial. Arthritis Rheum 2005; 52(2): 501–13PubMedCrossRef
24.
Sfikakis PP, Boletis JN, Tsokos GC. Rituximab anti-B-cell therapy in systemic lupus erythematosus: pointing to the future. Curr Opin Rheumatol 2005; 17: 550–7PubMedCrossRef
25.
Anolik JH, Barnard J, Cappione A, et al. Rituximab improves peripheral B cell abnormalities in human systemic lupus ertheymatosus. Arthrtis Rheum 2004; 50(11): 3580–90CrossRef
26.
Marks SD, Patey S, Brogan PA, et al. B lymphocyte depletion therapy in children with refractory systemic lupus erythematosus. Arthritis Rheum 2005; 52(10): 3168–74PubMedCrossRef
27.
McCune WJ, Riskalla MM. Mycophenolate mofetil: a magic bullet for lupus? J Rheum 2005 Jun; 32(6): 1047–52
28.
Kimball JA, Pescovitz MD, Book BK, et al. Reduced human IgG anti-ATGAM antibody formation in renal transplant recipients receiving mycophenolate mofetil. Transplantation 1995 Dec; 60(2): 1379–83PubMedCrossRef
29.
Raab M, Daxecker H, Pavlovic V, et al. Quantification of the influence of mycophenolic acid on the release of endothelial adhesion molecules. Clin Chim Acta 2002 Jun; 320(1–2): 89–4PubMedCrossRef
30.
Lui SL, Tsang R, Wong D, et al. Effect of mycophenolate mofetil on severity of nephritis and nitric oxide production in lupus-prone MRL/lpr mice. Lupus 2002; 11(7): 411–8PubMedCrossRef
31.
Shimizu H, Takahashi M, Takeda S, et al. Mycophenolate mofetil prevents transplant arteriosclerosis by direct inhibition of vascular smooth muscle cell proliferation. Transplantation 2004 Jun; 77(11): 1661–7PubMedCrossRef
32.
Ginzler EMAC, Buyon J, Dooley MA, et al. A multicenter study of mycophenolate mofetil (MMF) vs intravenous cyclophosphamide (IVC) as induction therapy for severe lupus nephritis (LN); preliminary results [abstract]. Arthritis Rheum 2003; 48 Suppl.: S647
33.
Hu W, Liu Z, Chen H, et al. Mycophenolate mofetil vs cyclophosphamide therapy for patients with diffuse proliferative lupus nephritis. Chin Med J (Engl) 2002; 115: 705–9
34.
Contreras G, Pardo V, Leclercq B, et al. Sequential therapies for proliferative lupus nephritis. N Engl J Med 2004; 350: 971–80PubMedCrossRef
35.
Fu YF, Lu GL. Mycophenolate mofetil therapy for children with lupus nephritis refractory to both intravenous cyclophosphamide and cyclosporine. Clin Nephrol 2001 Apr; 55(4): 318–21PubMed
36.
Buratti S, Szer S, Spencer CH, et al. Mycophenolate mofetil treatment of severe renal disease in pediatric onset systemic lupus erythematosus. J Rheumatol 2001 Sep; 28(9): 2103–8PubMed
37.
Fu LW, Yang LY, Chan WP, et al. Clinical efficacy of cyclosporin A neoral in the treatment of paediatric lupus nephrtitis with heavy proteinuria. Br J Rheumatol 1998; 37: 217–21PubMedCrossRef
38.
Nossent HC, Koldingsnes W. Long-term efficacy of azathioprine treatment for proliferative lupus nephritis. Rheumatology 2000; 39: 969–74PubMedCrossRef
39.
Kalunian KC, Davis JC, Merrill JT, et al. IDEC-131 Lupus study group. Treatment of systemic lupus erythematosus by inhibition of T cell co-stimulation with antiCD154: a randomised double-blind, placebo controlled trial. Arthritis Rheum 2002; 46: 3251–8
40.
Boumpas DT, Furie R, Manzi S, et al. A short course of BG9588 (anti-CD40-ligand antibody) improves serologic activity and decreases hematuria in patients with proliferative lupus glomerulonephritis. Arthritis Rheum 2003; 48: 719–27PubMedCrossRef
41.
42.
43.
44.
Smolen JS, Steiner G, Aringer M. Anti-cytokine therapy in systemic lupus erythematosus. Lupus 2005; 14: 189–91PubMedCrossRef
45.
46.
Stohl W. Systemic lupus erythematosus: a blissless disease of too much BLys (B lymphocyte stimulator) protein. Curr Opin Rheumatol 2002; 14: 522–8PubMedCrossRef
47.
Petri M, Jones RJ, Brodsky RA. High-dose cyclophosphamide without stem cell transplantation in systemic lupus erythematosus. Arthritis Rheum 2003 Jan; 48(1): 166–7322PubMedCrossRef
48.
Moroni G, Tantardini F, Ponticelli C. Renal replacement therapy in lupus nephritis. J Nephrol 2003; 16: 787–91PubMed
49.
Stone JH, Millward CL, Olson JL, et al. Frequency of recurrent lupus nephritis among ninety-seven renal transplant patients during the cyclosporine era. Arthritis Rheum 1998; 41: 678–86PubMedCrossRef
50.
Goral S, Ynares C, Shappell SB, et al. Recurrent lupus nephritis in renal transplant recipients revisited: it is not rare. Transplantation 2003; 75: 651–6PubMedCrossRef
51.
52.
Ilei GG, Austin HA, Crane M, et al. Combination therapy with pulse cyclophosphamide plus pulse methylprednisolone improves long-term renal outcome without adding toxicity in patients with lupus nephritis. Ann Intern Med 2001; 135: 248–57
53.
Rudge S, Hailwood S, Home A, et al. Effects of once-weekly oral alendronate on bone in children on glucocorticoid treatment. Rheumatology 2005; 44: 813–8PubMedCrossRef
Metadata
Title
Pharmacotherapy of Lupus Nephritis in Children
A Recommended Treatment Approach
Authors
Alexa Adams
Emma Jane MacDermott
Dr Thomas J. A. Lehman
Publication date
01-06-2006
Publisher
Springer International Publishing
Published in
Drugs / Issue 9/2006
Print ISSN: 0012-6667
Electronic ISSN: 1179-1950
DOI
https://doi.org/10.2165/00003495-200666090-00003

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