Rheumatologists Talking about Lupus Treatment in India

Author: Sandy

Posted On: April 10, 2014

Q. What are the medical treatments recommended for one having Lupus Nephritis in India?

A: “The management of SLE nephritis depends upon the stage of disease. In India the management strategy follows the guidelines recommended by American College of Rheumatology (ACR).

Well, there are 6 stages.

Stage 1 and 2 are managed with oral medication e.g. prednisolone, hydroxychloroquine with or without angiotensin converting enzyme inhibitors/ angiotensin receptor blockers. The severe forms of lupus nephritis are stage 3 and above for which treatment is more complicated. Treatment for stage 6 is not preferred because there is no improvement with such therapy.

The strategy divided into two phases… Induction and maintenance phase. The flow chart for treatment is as follows–

Lupus Treatment Chart

ACR guideline for Class III/IV induction therapy. MMF – mycophenolate mofetil. cyclophosphamide (CYC), GC -glucocorticoids; IV – intravenous, AZA – azathioprine; BSA – body surface area.

Lupus treatment chart 2

Healing procedure of class V devoid of proliferative changes and with nephrotic range proteinuria (_3 gm/24 hours)(ACR guideline).

Stage 6 requires renal replacement therapy (e.g. dialysis, renal transplantation).”

Discussion

    1. If the treatment hast be switched from Tacrolimus to Mycophenolate what how long a period do you recommend as a gap?

      • Hello Anupama,

        Thank you for stopping by and querying.

        Well, there is no such recommendation as per guideline. If someone has been using tacrolimus and it is poorly effective or there is development of side effects of tacrolimus such as nephrotoxicity, then doctors have to add mycophenolate mofetil(MMF) to tacrolimus and gradually reducing the dose of tacrolimus to reduce its side effects.
        It is recommended to start with MMF and steroid, and if the response is suboptimal then tacrolimus may be added[1][2] .There are various studies[3][4] in which combination therapy with tacrolimus, MMF and prednisolone used as induction regimen for lupus nephritis that fails to respond adequately to standard regimens.

        Hope, you find this helpful.

        Fight S.L.E

        List of references;
        [1] : J. Cortés-Hernández, M. T. Torres-Salido, A. S. Medrano, M. V. Tarrés, and J. Ordi-Ros, “Long-term outcomes—mycophenolate mofetil treatment for lupus nephritis with addition of tacrolimus for resistant cases,” Nephrology Dialysis Transplantation, vol. 25, no. 12, pp. 3939–3948, 2010.
        [2] : C. M. Lanata, T. Mahmood, D. M. Fine, and M. Petri, “Combination therapy of mycophenolate mofetil and tacrolimus in lupus nephritis,” Lupus, vol. 19, no. 8, pp. 935–940, 2010.
        [3] :Mok CC, To CH et al: Combined low-dose mycophenolate mofetil and tacrolimus for lupus nephritis with suboptimal response to standard therapy: a 12-month prospective study. Lupus. 2013 Oct;22(11):1135-41
        [4] : H. Bao, Z.-H. Liu, H.-L. Xie, W.-X. Hu, H.-T. Zhang, and L.-S. Li, “Successful treatment of class V+IV lupus nephritis with multitarget therapy,” Journal of the American Society of Nephrology, vol. 19, no. 10, pp. 2001–2010, 2008

    Leave a Reply

    Your email address will not be published. Required fields are marked *