Two Agents Better Than One (Other) for Lupus Nephritis

November 21, 2014
Norman Bauman

In lupus nephritis, tacrolimus combined with mycophenolate mofetil delivers better remission rates than cyclophosphamide alone.

Liu Z, Zhang H, Liu Z, et al. Multitarget Therapy for Induction Treatment of Lupus Nephritis: A Randomized, Controlled Trial. Ann Intern Med. 2014 doi:10.7326/M14-1030 Online November 11.

The combination of tacrolimus and mycophenolate mofetil induces almost twice as many complete remissions as intravenous cyclophosphamide alone in lupus nephritis, according to a Chinese study.

Their hypothesis is that induction treatment with the two drugs targets different aspects of the immune response, and may be more effective than a single agent. Tacrolimus not only inhibits T-cell proliferation, but also protects glomerular podocytes independent of immunosuppressive effects, the researchers explain.

All 368 patients at 26 renal centers were treated initially with methylprednisolone followed by tapered oral prednisone.

The primary endpoint of complete remission at 24 weeks was defined as urinary protein, urine sediments, serum albumin, and serum creatinine.

In combination group, 46% reached the endpoint versus 26% in the cyclophosphamide group.

Overall response incidence came in highest in the combination group. The median time to overall response also clocked in faster in the combination group at 9 rather than 13 weeks. The incidence of adverse events is the same.

Patientswith Class IV disease see the greatest advantage with combination treatment, the authors state. These patients show a higher rate of remission than previous studies. (However, it's possible that Chinese patients are more susceptible than others to immunosuppressive agents, they add.)