Updates in Glomerular Diseases – Lupus Nephritis

Gerald Appel, MD (Columbia University)

This was a good review of trials in the last 5-7 years regarding lupus nephritis.  Since no new data was really presented, I’ll just briefly go over the key points of the trials he mentioned.

• Eurolupus:  a lower dose of cyclophosphamide (CYC) (500 mg q2 weeks for 3 months) was just as effective as the traditional high-dose CYC (based on body surface area) at inducing remission of WHO Class III and IV lupus nephritis (with less side effects)
• ALMS:  MMF is just as good as CYC in inducing remission in lupus nephritis
• ALMS II:  MMF just as good as AZA in maintaining remission in lupus nephritis
• MAINTAIN:  a European trial that showed no difference between AZA and MMF in maintaining remission
• LUNAR:  when comparing rituximab (RTX) + MMF to MMF alone, there was no significant difference in any renal endpoint and none of the patients developed progressive multifocal leukoencephalopathy (PML) in the RTX arm

New trials are underway looking at belimumab (Benlysta).  It’s the first drug approved for lupus in the last 50 years, but hasn’t been studied in lupus nephritis patients just yet.

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