asn.2016040415f1

Current standard of care treatment protocols for LN induction therapy. Patients with proliferative forms of LN are treated with oral corticosteroids, typically prednisone starting at 1 mg/kg per day and tapered over weeks to months. In severe disease with rapid deterioration of kidney function, high-dose intravenous methylprednisolone (0.25–1 g/d) is often given for 1–3 days preceding oral corticosteroids. In addition to corticosteroids one of four immunosuppressive regimens using cyclophosphamide or MMF is generally used. The NIH high-dose regimen consists of monthly intravenous pulses of cyclophosphamide dosed at 0.5–1 g/m2 for 6 months. Oral cyclophosphamide dosed at 1–1.5 mg/kg per day for 2–4 months provides a cumulative cyclophosphamide burden similar to the NIH regimen. In both cases cyclophosphamide is dosed based on nonobese body weight. The Euro-Lupus (low-dose) intravenous cyclophosphamide regimen is dosed at 500 mg every 2 weeks for six total doses. Cumulative cyclophosphamide for the Euro-Lupus regimen is 3 g, which is at least 50% lower than the NIH regimen. MMF is given for 6 months and dosed at 2–3 g/d. | Parikh, S. V., & Rovin, B. H. (2016). Current and Emerging Therapies for Lupus Nephritis. Journal of the American Society of Nephrology : JASN, 27(10), 2929–2939. doi:10.1681/ASN.2016040415

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