Once remission is achieved in systemic lupus erythematosus (SLE) nephritis, what maintenance therapy should be given?

Updated: Aug 04, 2021
  • Author: Christie M Bartels, MD, MS; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Once remission is achieved, start maintenance therapy with azathioprine or mycophenolate mofetil (ie, use less potent agents relative to long-term cyclophosphamide). The ALMS maintenance trial also found that mycophenolate mofetil was superior to azathioprine in the maintenance of the renal response to treatment and in the prevention of relapse in patients with lupus nephritis. [146] In the MAINTAIN trial, there was a trend toward fewer renal flares in patients receiving mycophenolate mofetil than in those receiving azathioprine [147] ; however, these results did not reach statistical significance.

When Griffiths et al compared the corticosteroid-sparing effect of cyclosporine with azathioprine in patients with severe SLE, they concluded that azathioprine may be considered first-line therapy, whereas cyclosporine requires close monitoring of blood pressure and serum creatinine. However, the investigators noted that in patients who are unable to tolerate azathioprine, cyclosporine may be considered. [148]


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